Multilevel congenital ureteral obstruction in a two-year-old child: Staged reconstruction with neo-implantation and V-Y pyeloplasty

Multilevel congenital ureteral obstruction involving the ureteropelvic junction (UPJ) and ureterovesical junction (UVJ) is exceedingly rare condition in pediatric urology and may cause progressive hydronephrosis and renal impairment if untreated. We report a two-year-old boy with antenatally detected right-sided hydronephrosis caused by obstruction involving the UPJ, mid-ureter, and UVJ, previously managed with nephrostomy. Magnetic resonance urography demonstrated massive hydronephrosis and delayed renal excretion. The reconstructive surgery using non-dismembered V–Y pyeloplasty and ureteral neo-implantation with double-J stenting successfully restored urinary continuity and preserved renal function. This staged, anatomy-based strategy appears safe and effective for multilevel congenital ureteral obstruction. • Rare multilevel ureteral obstruction involving UPJ, mid-ureter, and UVJ. • Severe hydronephrosis detected antenatally with progressive enlargement. • MRI showed high-grade obstruction with organ displacement and poor drainage. • Staged V-Y pyeloplasty and ureteral neo-implantation restored urine flow. • Personalized reconstruction effective for complex congenital ureteral disease.