Hydronephrosis is diagnosed antenatally in approximately 1-5% of all pregnancies. A rare cause is ureteral stricture, found in 4% of these cases. This study reports a series of 28 strictures diagnosed over a 10-year period by magnetic resonance urography (MRU) (mean age 2.4 years, range four weeks – 15 years) of which 22% were also diagnosed by renography or renal ultrasound scan. Twenty cases presented with hydronephrosis, three had pain, two had incontinence, and one each presented with either urinary infection, cystic kidney or an absent kidney. All patients required a general anaesthetic for the MRU. Twenty-eight cases required treatment for ureteric strictures (10 with ureteroureterostomy, six with excision and ureteroneocystostomy, three with nephrectomy or partial nephrectomy for non functioning / poorly functioning kidneys), all being diagnosed at a mean age of 2.4 years ( range four weeks – 15years). Eight cases were followed up conservatively with ultrasound scans without surgery and were described as having “Lesser clinical significance”, as calculated by the renal transit time on the renogram. Two of the eight cases had strictures associated with multicystic dysplastic kidneys and need no operation because of this. The authors conclude that MRU should be considered in children where there is a suspicion of ureteral stricture as it provides optimal management in terms of localisation of the stricture and levels of function. 

Magnetic resonance urography for diagnosis of pediatric ureteral stricture.
Arlen A, Kirsch A, Cuda S, et al.
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Henrik Steinbrecher

Southampton University Hospital NHS Trust

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