Pediatric ureteric strictures are a rare occurrence. While it is treatable, ureteric stricture in infants can have adverse effects on their life as they age. Strictures are generally common among the ageing population, who need to make certain lifestyle and dietary changes to keep the risk of recurrence low. In the case of strictures in infants, they have to follow the same guidelines throughout their life just to live healthily. So, let’s take a closer look at how to identify ureteric strictures in children, the management of ureteric strictures in pediatric patients, and the diagnosis and treatment of pediatric ureteric strictures. But first, let’s look at the causes behind childhood ureteric obstruction.

Causes of Ureteric Strictures in Children

Ureteric strictures have fewer causes when it comes to children than adults. Unlike adults, the risk of ureteric strictures can be identified early after the child’s birth because, in most cases, ureteric stricture in children is caused by congenital abnormalities. However, there are other cases as well. So, let’s look at the different reasons children can get ureteric strictures.

• Congenital Abnormalities: Sometimes, children are just born with a narrow ureter, which can be a birth defect or caused due to genetics. This is one of the leading causes of ureteric strictures in children. In most cases, the doctors can get an early diagnosis of this condition after the child’s birth and can create a treatment plan to help them live healthily.
   
• Injury: Children fall down a lot, and in case of severe or repeated injuries, it can cause ureteric strictures. The damage to the ureter walls from the injury can create scar tissues there, which can stop the flow of urine. This is also a common cause of ureteric stricture in children. However, it is a rare occurrence that parents don’t need to be wary against particularly.
   
• Radiation Therapy: This is the rarest among the causes of ureteric strictures in children, but it is possible. The radiation therapy used for treating illnesses like cancer can negatively impact the ureter and cause the formation of strictures. However, it could take years for the strictures to form in this case.

How To Identify Ureteric Strictures in Children?

Ureteric strictures don’t always show telltale symptoms in the early stages. This is all the more true when it comes to children. However, if they show certain symptoms, it is at least easier to diagnose ureteric strictures in children than in adults. Why? Because the number of conditions that can cause said symptoms are limited in children compared to adults. So, what are the symptoms that you should look out for, and how to identify them? Let’s find out.

• Difficulty Urinating: This is the most important symptom that parents should look out for because it is one of the primary symptoms of ureteric strictures. Signs of this symptom include difficulty starting to urinate, difficulty maintaining a steady stream of urine, and pain or a burning sensation while urinating. These symptoms are similar for both boys and girls and require medical attention to diagnose the underlying problem as soon as possible.
   
• Lower Back & Side Pain: Ureteric strictures put unnecessary pressure on the kidneys, which can cause lower back and side pain. If your child complains about a dull ache in their lower back or radiating pain that goes down to their pelvic area, it can be a sign of ureteric strictures. So, ensure you get medical attention at the earliest if your child is complaining about a similar type of pain.
   
• Nausea & Vomiting: Combined with the previous symptoms, if your child is vomiting regularly and having feelings of nausea, it can be an indication of ureteric strictures. Please get the necessary medical attention to your child at this point.

Diagnosis & Treatment of Pediatric Ureteric Strictures

Pediatric ureteric strictures can be diagnosed with both invasive and non-invasive procedures. For children that have congenital issues such as a narrow ureter, doctors can inform parents of the risks even before the child is born. In such cases, given the risk factors, doctors might move directly toward treatment. For the other cases where the condition has developed due to other causes, here are some of the most commonly used diagnostic tests. These are used to understand the problem and perform ureteric stricture repair in children.

• X-rays: X-rays using a contrast medium are one of the best non-invasive diagnostic processes for children. They can help doctors look inside the body and see where the stricture is in the ureter and its length. This information is crucial in setting up a treatment plan for the child. Plus, X-rays are quick and can be performed without scaring or hurting the child.
   
• CT Scan: CT Scans are also a great example of non-invasive diagnostic tests that are used to diagnose ureteric strictures. These tests have the same benefits as X-rays; only CT scans can provide an even better image of the ureters to view the stricture clearly and create the treatment plan accordingly.
   
• Ureteroscopy: Ureteroscopy is an invasive diagnostic test that is used to view the stricture from the inside. A scope with a camera is inserted into the urethra of the child, and it is navigated into the ureter from the bladder to look at the stricture. This procedure is performed on an outpatient basis under general anesthesia (if required). Copious amounts of lubrication are used to ensure the urinary tract is not bruised by the scope when inserted into the body. This is one of the best diagnostic processes to find out if your child has ureteric strictures or not.

When it comes to treating ureteric strictures in infants and children, minimally invasive endoscopic treatment of pediatric ureteric strictures is the most common procedure prescribed. These are some of the most successful options for surgical treatment of ureteric obstruction in children. Let’s take a look at the different procedures used.

• Ureterorenoscopy: This is one of the most effective treatment options for ureteric strictures in both children and adults. The procedure involves cutting out or melting the stricture using surgical tools or lasers. No incisions are made into the skin for this procedure as the surgical instruments are inserted into the body through the urethra. This procedure is highly specialized and is one of the only permanent treatment options for ureteric strictures in children. If the strictures are cut out of the body, often other tissues are grafted in their place to ensure the proper functioning of the ureter.
   
• Balloon Dilation: Balloon dilation is one of the easiest treatment options for ureteric strictures, and it is highly effective in treating strictures less than a centimeter in length. A balloon is inserted into the body through the urethra. Once it is navigated to the stricture, it is inflated to clear out the stricture in the ureter. This procedure is simple, and even if the stricture is larger than 1 cm, multiple dilations are often prescribed to ensure the stricture is cleared because of the low-risk factors of this procedure.
   
• Stent Placement: Stents are also commonly used for ureteric strictures. The procedure is performed under general anesthesia, and the stent is inserted into the body through the urethra. Stents are a temporary solution, but they can be very effective in treating the symptoms of ureteric strictures. When it comes to children, stents can be an effective way to treat strictures and allow the patients to live normally. However, repeated procedures have their own risks to the urological health of the patient.

Conclusion

If your child is going through the symptoms of ureteric strictures or they have congenital issues, feel free to visit us at MASSH. We offer specialized minimally invasive treatment options for ureteric strictures of all stages. Our experienced team and world-class infrastructure allow patients to recover quickly and safely without the risk of recurrence. For more information about ureteric stricture treatment at MASSH, feel free to check out the options on our website.