Congenital Mid-ureteral Stenosis with Pelviureteric Junction Obstruction – An Intraoperative Surprise

Pelviureteric junction obstruction (PUJO) is typically diagnosed through ultrasound and dynamic renal scintigraphy. This report describes a 5-year-old boy with right flank pain diagnosed as PUJO. Imaging revealed a narrowing at the pelvi-ureteric junction, and a subsequent diuretic renal scan indicated obstructed drainage. During surgery, a second narrowing due to congenital mid-ureteral stenosis was discovered, necessitating an excision of the obstructed ureter segment and pyeloplasty. This report highlights the rarity of Congenital Midureteral Stenosis (CMUS) and the challenges in diagnosing it, especially when it coexists with PUJO. Literature search revealed limited previous reports of this dual obstruction, stressing the importance of careful surgical evaluation in suspected cases of urinary obstruction.