Midureteral Hypoplasia at Congenital Midureteral Stricture

Jong Jin Oh; Woong Gi Jang; Sang Hyun Jee; Young Kwon Hong

doi:10.4111/kju.2008.49.6.570

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Oh, Jang, Jee, and Hong: Midureteral Hypoplasia at Congenital Midureteral Stricture

Original Article

Korean J Urol 2008;49(6):570-573.

Published online: 21 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.6.570

Midureteral Hypoplasia at Congenital Midureteral Stricture

Jong Jin Oh, Woong Gi Jang, Sang Hyun Jee, Young Kwon Hong

Department of Urology, College of Medicine, Pochon CHA University, Seongnam, Korea

Received 27 December 2008 Accepted 13 May 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hydronephrosis is the most common abnormal finding of genitourinary tract detected by fetal ultrasonography. The causes of majority are attributed to ureteropelvic junction (UPJ) obstruction. The remaining are secondary to vesicoureteral reflux, megaureter, or posterior urethral valves. Congenital midureteral stricture is an unusual cause of hydronephrosis. We report a case in a one month old male baby with hydronephrosis (grade V, 20mm in AP diameter). He was diagnosed as a ureteropelvic junction obstruction. A mid ureteral stricture was identified with intraoperative anterograde pyelography. After removal of severely strictured ureter, the dilated proximal end was anastomosed to the spatulated distal ureter by microscope. Pathologic finding was subepithelial fibrosis and segmental inner smooth muscle attenuation. Ureteral stent was removed 2 months after surgery. Degree of hydronephrosis was markedly reduced on the follow up ultrasonography (14mm in AP diameter) 6 months after surgery.

Keywords: Prenatal hydronephrosis, Midureteral stricture

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Fig. 1.

Preoperative renal ultrasonography. Severe hydronephrosis is noted in the left kidney, measuring 20mm in AP diameter.

Fig. 2.

Preoperative diuretic renogram. Severe hydronephrosis of left kidney with poor reaction to diuretics.

Fig. 3.

Intraoperative anterograde pyelography. Arrow indicates an abrupt narrowing of ureter.

Fig. 4.

Pathologic finding showing subepithelial fibrosis and segmental inner smooth muscle attenuation.

Fig. 5.

Postoperative renal ultrasonography. Decreased hydronephrosis of left kidney with 14mm in AP diameter.

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