Ureteral Stricture
What is it?
Ureteral stricture is a narrowing of the lumen of
the ureter, the ducts that carry urine from the kidneys
to the bladder, resulting in an obstruction. Ureteral
strictures may arise from a variety of causes and are
characterized as either anastomotic or nonanastomotic,
depending on how they develop. They may also be benign
or malignant.
Who gets it?
Any individual undergoing treatments such as an
ureteroscopy for kidney, gall or urinary bladder stone
management or urinary diversion is at a greater risk
for developing a ureteral stricture.
What causes it?
Ureteral strictures may be caused by external trauma
or develop after treatment for another condition.
Ureteral strictures may be inflammatory due to
gonorrhea, tuberculous urethritis, or schistosomiasis,
or as a rare complication of cancer.
Nonanastomotic ureteral strictures may develop after
stone impaction or upper urinary tract endoscopy, as
well as following pelvic radiation therapy and a
variety of open and laparoscopic surgical procedures or
other trauma.
Anastomotic ureteral strictures may develop as a
result of a urinary diversion surgery.
What are the symptoms?
Symptoms of ureteral strictures are pain or
difficulty urinating, a weak stream, splaying of the
urinary stream, urinary retention, and urinary tract
infection. A doctor may be able to detect evidence of
scarring due to trauma or a tumor.
How is it diagnosed?
A doctor may perform a urethroscopy to reveal the
degree of narrowing of the urethra. The patient may
also undergo another procedure, retrograde urethrogram,
to determine the site and degree of stricture.
Additional tests may be needed to differentiate a
bladder outlet obstruction due to prostatism, impacted
urethral stones, urethral foreign bodies and tumors. If
tumors are present, the doctor will conduct additional
tests to determine if they are malignant (cancerous) or
benignant (non-cancerous).
What is the treatment?
There are a variety of minimally invasive treatments
for patients with ureteral strictures. A doctor may
perform balloon dilation as a first step in treatment,
particularly in patients who have nonanastomotic
strictures.
For ureteral strictures that do not respond
favorably to dilation alone, endoscopic incision is the
procedure of choice for most patients. Endoscopic
incision of the stricture can be performed or a laser
may be used with a rigid or flexible ureteroscope. A
stent may be left in place to keep the ducts open for
approximately 6 weeks.
Finally, newer techniques called are now available
that may allow for long-term relief of a ureteral
stricture if other techniques are unsuccessful.
Self-care tips
Follow-up care for a patient undergoing treatment
for a ureteral stricture may include imaging testing
such as renal ultrasound, IVP, or renal scintigraphy
two to four weeks after the stent is removed.
If the patient is asymptomatic, imaging is performed
again at three months and then at six-month intervals
for the first two years following treatment. Most
ureteral stricture recurrences are identified within
the first year after surgery.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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