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 get it?
Any individual undergoing treatments such as an ureteroscopy for kidney, or uretric stone management or urinary diversion is at a greater risk for developing a ureteral stricture.
Causes
Ureteral strictures may be caused by external trauma or develop after treatment for another condition. Ureteral strictures may be inflammatory due to gonorrhea, tuberculous uretritis, 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.
Symptoms
Symptoms of ureteral strictures are pain or loin lump (mars) or flank tenderness, and urinary tract infection
Diagnosis
It is diagnosed by an IVU (Intraveneous Urogram) or retrograde urethrogram, to determine the site and degree of stricture.
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 Holmium Laser Endoureterotomy are now available that may allow for long-term relief of a ureteral stricture if other techniques are unsuccessful.
