Ureteric (or “ureteral”) stricture is the limiting of the urine flow through either or both of the ureters, which impedes the body’s ability to pass urine. Ureteric stricture can occur in varying severity from light strictures with limited symptoms and some continued flow of urine, to complete and acute obstructions with severe symptoms and no urine passage. Symptoms or suspicions of ureteric stricture should always be consulted with a doctor.
Learn about the ureters
Ureteric stricture can arise from a variety of causes ranging from side effects of scar tissue from surgery surrounding the ureters, to radiation therapy for prostatic and other types of cancer, kidney stone management, as well as from external traumatic injury. In some cases, patients may also have been born with ureteric stricture.
Diagnosis of ureteric stricture may involve medical and physical examination, x-ray imaging, ultrasound, CT scan, MRI scan, as well as possibly ureteroscopy, where a scope is inserted through the urethra past the bladder and into the ureters to see if a stricture has occurred. Pyelograms or nephrostograms may also be used in combination with injection of contrast fluid to examine the ureters and kidneys.
The symptoms of ureteric stricture typically vary in magnitude depending on the severity of the stricture. If you are in doubt about whether you are experiencing symptoms, a doctor can examine and evaluate if treatment is necessary. Examples of ureteric stricture symptoms can be seen below
The optimal treatment of ureteric stricture will typically depend on patient history, the severity of the symptoms as well as the length of the stricture. Below follow examples of how ureteric strictures can be treated including examples of their respective advantages and disadvantages.
If the symptoms of penile urethral stricture are limited in severity and do not interfere with the patient’s everyday life, some doctors may prefer to simply monitor the condition and follow up frequently to evaluate the development in symptoms closely. Watchful waiting has the advantage of no side-effects or complications but comes with the risk that the condition is not treated in due time.
Balloon dilatation is typically the first methods attempted to provide symptom relief. Balloon dilatation is generally performed under local anesthesia by means of a special balloon catheter which stretches the stricture to provide urine passage. Balloon dilatation is non-invasive, but often must be repeated regularly to sustain the passage and does cause risk of e.g. bleeding and infection.
The stricture can also be cut open by use of laser or a scalpel. Incisions are more invasive than balloon dilatation but typically provide longer term symptom relief. A catheter may be inserted through the stricture to hold open the gap after the incision, to allow it to heal. Though more effective than dilatations, some strictures reappear after a period, upon which a new incision or a different treatment can be performed.
JJ-catheters are long plastic tubes plastic inserted through the stricture under typically general anesthesia to enable urine flow. The catheters are inserted into the kidneys to prevent migration but will normally need replacement every three months to avoid blockage. JJ-catheters are less invasive than surgery, but may cause discomfort and pain to the user, and affect quality of life through the frequent need for changes.
Percutaneous nephrostomy is the placement of a catheter through the skin on the back or flank, and into the kidneys in order to drain urine. The catheter is connected to a disposable bag strapped onto the body to collect the urine. Nephrostomy is an effective way to drain urine, but causes risk of infection and bleeding, and may cause discomfort and affect quality of life.
Ureteric stricture may also be treated through reconstruction surgery called, Laparoscopic pyeloplasty, which is the reconstruction of the obstructed area where the ureter attaches to the kidney. Pyeloplasty is an effective way of treating ureteric obstruction but is a major surgery with its known risk of side-effects and is in general more invasive than catheters and stents.
Stents are short tubes fixed at the location of the stricture to allow urine to pass through. Stents are less invasive than surgery and affect the everyday life of patients less than catheters, but cause risk of obstruction from kidney stones, and may pass involuntarily through the urine. In either case the stents can be replaced by a new one or replaced with different treatment method. Certain non-metallic stents also cause risk of tissue growth into the stent, making the removal process difficult.
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