Bilateral congenital midureteric stricture

摘要

Midureteric stricture is a rare cause of congenital hydronephrosis. Its etiology and pathophysiology is uncertain. We report a case of an 8 year old male child who presented with recurrent urinary tract infections and moderate renal impairment. Sonar revealed bilateral hydronephrosis. This was confirmed to be due to intrinsic midureteric narrowing on MRU. Bilateral ureteric exploration confirmed these findings and uretero-ureterostomy was performed. Postoperative imaging showed improvement in hydronephrosis. We review the published literature. Case report An 8 year old boy was admitted to our institution with a documented UTI. He had no significant past medical history. Physical examination was non-contributory. He was in moderate renal impairment with a serum Creatinine of 130mmol/l and an estimated Creatinine Clearance, using the Schwartz formula, of 50ml/min/m?. Urine cultures for Tuberculosis were negative.Renal sonar revealed gross bilateral hydroureteronephrosis with thin renal cortices. The bladder appeared normal. Of note no ureteric dilatation was seen at the level of the bladder. An MCUG revealed a normal bladder and posterior urethra with no reflux. Radioisotopic mercaptoacetyltriglycine (MAG3) renography showed poor uptake bilaterally with apparent holdup at the midureteric level.In view of the unusual imaging and to exclude extrinsic retroperitoneal pathology a Gadolinium enhanced magnetic resonance urogram was requested. This showed no retroperitoneal pathology, but bilateral midureteric obstruction. (See Figure 1).