Prenatal diagnosis of a rare form of congenital mid-ureteral stricture: a case report and literature revisited

BACKGROUND: Congenital mid-ureteral stricture is a rare malformation of the ureter leading to prenatal and neonatal hydronephrosis. Site characterization of the narrowing is important to optimize the surgical approach to the newborn affected by hydronephrosis. CASE PRESENTATION: We report a female EM with a rare form of hydronephrosis, (i.e. mid-ureteral stricture) which was detected early during pregnancy by imaging techniques. During fetal life both conventional fetal Ultrasound and maternal Magnetic Resonance Imaging (MRI) were used to diagnose the obstruction. Magnetic Resonance pyelography and retrograde Ureteropyelography were performed after delivery and before surgical correction and confirmed the finding. Furthermore, we revisited the literature using online MEDLINE and EMBASE databases. The literature reported only a few cases of prenatal diagnosis of early onset mid-ureteral stricture. CONCLUSION: Mid-ureteral stricture is a rare cause of prenatal hydronephrosis. The diagnosis should not be delayed in order to apply the appropriate surgical approach. As a result, we showed the usefulness of fetal MRI and postnatal Magnetic Resonance pyelography, in the event that radionuclide renography with Tc-MAG3 was less informative, to allow the detection of the site of ureteral narrowing. Intrasurgical retrograde ureteropyelography confirmed these findings.