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

RATIONALE: 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. PATIENT CONCERNS: 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. DIAGNOSES: 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. INTERVENTIONS: The patient underwent laparoscopic segmental ureteral resection with primary anastomosis, concomitant laparoscopic ureteral stent placement, and postoperative anti-inflammatory therapy. OUTCOMES: 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. LESSONS: 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.