Adolescent idiopathic ureteral stricture: A multimodal diagnostic and surgical approach in resolving hydronephrosis

Idiopathic ureteral strictures in adolescents are rare and poorly understood, posing diagnostic and therapeutic challenges due to their unclear etiology and lack of pediatric-specific management guidelines. Existing evidence predominantly derives from adult studies, leaving gaps in understanding pathophysiology, optimal interventions, and long-term outcomes in younger populations.

A 16-year-old male presented with asymptomatic left hydronephrosis detected during routine physical examination. Laboratory tests revealed elevated white blood cell count (12 × 10⁹/L) and 1+ leukocytes in urinalysis, prompting further investigation.

Imaging modalities, including urinary tract ultrasound and computed tomography urography, identified severe left hydronephrosis and pelvic ureteral wall thickening. Ureteroscopy and retrograde pyelography localized a stricture at the fifth lumbar vertebra level. Histopathological analysis confirmed chronic inflammation, vascular hyperplasia, and polypoid proliferation at the stricture site.

The patient underwent laparoscopic segmental ureteral resection with primary anastomosis, concomitant laparoscopic ureteral stent placement, and postoperative anti-inflammatory therapy.

Follow-up computed tomography urography at 3 months demonstrated complete resolution of hydronephrosis and successful stent removal. The patient remained asymptomatic with normalized laboratory parameters.

This case highlights chronic inflammation as a potential driver of idiopathic ureteral strictures in adolescents, contrasting with fibrosis-dominated adult cases. It validates multimodal imaging and surgical resection as effective diagnostic and therapeutic strategies while emphasizing anatomical vulnerability at the fifth lumbar vertebra. The findings advocate for pediatric-focused research to explore inflammatory biomarkers, genetic predispositions, and minimally invasive alternatives.