title: Magnetic resonance urography for diagnosis of pediatric ureteral stricture.
abstract: OBJECTIVE
  Ureteral stricture is a rare cause of hydronephrosis in children and is often misdiagnosed on ultrasound (US) and diuretic renal scintigraphy (DRS), requiring intraoperative diagnosis. We evaluated ureteral strictures diagnosed by magnetic resonance urography (MRU) at our institution.
  
  
  METHODS
  Children with ureteral stricture who underwent MRU were identified. Patient demographics, prior imaging, MRU findings, and management were assessed. The efficacy of MRU in diagnosis of stricture was compared with US and DRS. Patients with ureteropelvic or ureterovesical junction obstruction were excluded.
  
  
  RESULTS
  Twenty-eight ureteral strictures diagnosed by MRU between 2003 and 2013 were identified; 22% of strictures were diagnosed by DRS ± US. The mean age at MRU diagnosis was 2.4 years (range 4 weeks-15 years). Hydronephrosis was the most common presentation, accounting for 20 (71%) cases. Other etiologies included pain (3), incontinence (2), and urinary tract infection, cystic kidney, and absent kidney, present in one case each. A mean of 2.7 imaging studies was obtained prior to MRU diagnosis. Twenty-one (75%) ureteral strictures required surgical intervention, with the approach dependent upon location.
  
  
  CONCLUSIONS
  MRU provides excellent anatomic and functional detail of the collecting system, leading to accurate diagnosis and management of ureteral stricture in children.
authors: Department of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA. Electronic address: angarlen@gmail.com.
authors: Angela M
authors: AM
authors: Arlen
authors: Department of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA.
authors: Andrew J
authors: AJ
authors: Kirsch
authors: Department of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA.
authors: Scott P
authors: SP
authors: Cuda
authors: Department of Radiology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA.
authors: Stephen B
authors: SB
authors: Little
authors: Department of Radiology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA.
authors: Richard A
authors: RA
authors: Jones
authors: Department of Radiology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA.
authors: J Damien
authors: JD
authors: Grattan-Smith
authors: Department of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA. Electronic address: wcerwin@emory.edu.
authors: Wolfgang H
authors: WH
authors: Cerwinka
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009392:Nephrectomy; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014547:Urinary Diversion; D014567:Urography
keywords: Hydronephrosis; Magnetic resonance imaging; Obstruction; Ureteral stricture