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Title: More than meets the eye: intra-operative retrograde pyelography when more than one ureteral obstruction is suspected – A case report
Authors: El Masri, Marwa
Mantash, Mehdi
Abou-Malhab, Christina
Aftimos, Georges
Abou-Jaoudeh, Pauline
Diab, Nabil
Affiliations: Faculty of Medicine 
Keywords: Case report
Congenital mid-ureteral stricture
Multiple obstruction
Retrograde pyelography
Ureterovesical junction obstruction
Issue Date: 2023-06-01
Publisher: Elsevier
Part of: Journal of Pediatric Surgery Case Reports
Volume: 93
Background: Antenatal hydronephrosis can be caused by various congenital anomalies of the excretory urinary system. Common causes are isolated ureteropelvic junction obstruction and ureterovesical junction obstruction with isolated mid-ureteral stenosis occurring much less frequently. To our knowledge, the co-existence of a triple ureteral obstruction has never been previously reported in the literature. Case presentation: We herein report the case of a 7-month-old girl who presented for follow up on antenatal hydronephrosis and was diagnosed with ureterovesical junction obstruction. After ureteroneocystostomy was done, failure to introduce the ureteral catheter into the ureter and subsequent dissection showed a second obstruction: a mid-ureteral valve, that was resected. Then, failure to re-introduce the catheter a second time with subsequent retrograde pyelography revealed a third obstruction: a ureteropelvic junction obstruction. Conclusion: The co-existence of multiple ureteral obstruction is a rare condition that poses diagnostic problems, and whose treatment remains challenging. Early diagnosis and treatment of these serious conditions is imperative because of their detrimental consequences on renal function. Thus, the occurrence of multiple ureteral obstruction should always be borne in mind and investigated intra-operatively by retrograde pyelography whenever suspected.
DOI: 10.1016/j.epsc.2023.102645
Ezproxy URL: Link to full text
Type: Journal Article
Appears in Collections:Faculty of Medicine

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