Conditions & Treatments

Ureteral Stricture Disease

Need help now?

OVERVIEW

Ureteral stricture disease, also known as ureteral stricture or ureteral stenosis, is a medical condition characterized by the narrowing or constriction of one or both of the ureters. Ureters are muscular tubes that carry urine from the kidneys to the bladder, and when they become narrowed or blocked, it can lead to various health issues.

At the University of Kansas Urology Department, our dedicated team is committed to providing state-of-the-art care tailored to your unique needs. Our team places great emphasis on open communication and collaboration to ensure you receive the most personalized care possible. By actively engaging with you throughout your healthcare journey, we aim to empower you with the knowledge and confidence needed to make informed decisions about your well-being.

Types of Ureteral Stricture Disease

  • Intrinsic Ureteral Stricture: This type of stricture occurs due to structural abnormalities or damage within the ureter itself. Causes include scar tissue formation, inflammation, or congenital conditions.
  • Extrinsic Ureteral Stricture: Extrinsic strictures result from external pressure on the ureters. This pressure can be caused by adjacent structures such as tumors, fibrosis, or surgical procedures.

SYMPTOMS & CAUSES

Symptoms

The symptoms of ureteral stricture can vary depending on the severity and location of the stricture. Common signs and symptoms include:

  • Flank pain: Pain in the side of the abdomen or lower back, which can be mild to severe.
  • Hematuria: The presence of blood in the urine.
  • Urinary tract infections (UTIs): Recurrent UTIs may occur due to urine retention and bacterial growth.
  • Decreased urine output: Reduced urine flow or difficulty in urinating.
  • Hydronephrosis: Swelling of the kidney due to the backup of urine, which may be detected through imaging studies.

Causes

Several factors can lead to the development of ureteral strictures:

  • Infection: Chronic urinary tract infections can cause inflammation and scarring, leading to strictures.
  • Kidney stones: The passage of kidney stones through the ureter can damage the lining, leading to strictures.
  • Trauma: Injury to the ureter during surgery or accidents can result in strictures.
  • Radiation therapy: Radiation treatment for cancer in the pelvic area may cause ureteral damage.
  • Congenital abnormalities: Some individuals may be born with ureters that are naturally narrow, increasing their risk of developing strictures.
  • Tumors: Both benign and malignant tumors can exert pressure on the ureters, causing extrinsic strictures.
  • Inflammatory conditions: Conditions like interstitial cystitis or retroperitoneal fibrosis can lead to inflammation and scarring of the ureters.

DIAGNOSIS & SCREENING

  • Medical History and Physical Examination: The first step in diagnosis involves discussing your symptoms and medical history with a healthcare provider. A physical examination may also be conducted to assess any abdominal or flank tenderness.
  • Imaging Studies: Various imaging techniques may be employed to visualize the ureters and diagnose the stricture:
    • Ultrasound: This non-invasive test can provide initial information but may not offer the most detailed images of the ureters.
    • CT Scan: A computed tomography (CT) scan can provide detailed images of the urinary tract, helping identify the location and severity of the stricture.
    • MRI: Magnetic resonance imaging (MRI) may be used for further evaluation, especially if there are concerns about radiation exposure.
  • Urodynamic Tests: These tests can assess how well the urinary system is functioning and may help diagnose ureteral strictures:
    • Cystoscopy: A thin, flexible tube with a camera (cystoscope) is inserted through the urethra and into the bladder to examine the ureteral openings and the interior of the bladder.
    • Ureteroscopy: A narrow, flexible tube (ureteroscope) is passed through the bladder and into the ureter to directly visualize and assess the stricture.

TREATMENTS

The choice of treatment depends on the severity of the stricture, its location, and the underlying cause:

  • Medications: Antibiotics are prescribed to treat any associated infections, while pain relievers can help manage discomfort.
  • Ureteral Stenting: A stent, a tube-like device, can be temporarily placed within the ureter to keep it open. This is often a short-term solution to relieve symptoms.
  • Balloon Dilation: During this procedure, a balloon is inserted into the ureter and inflated to widen the stricture. It may provide relief in some cases.
  • Surgery: Surgical interventions are considered for more severe or complex strictures. Options include:
    • Ureteral Reimplantation: The affected portion of the ureter may be removed, and the remaining healthy sections are reconnected.
    • Ureteral Reconstruction: In cases of long or complicated strictures, reconstruction of the ureter with healthy tissue may be necessary.

OUTLOOK & PROGNOSIS

The prognosis for individuals with ureteral stricture disease varies depending on the underlying cause, the location and extent of the stricture, and the chosen treatment. In general:

  • Early diagnosis and appropriate treatment often lead to better outcomes.
  • Mild or short strictures may respond well to less invasive procedures like stenting or balloon dilation.
  • Severe or complex strictures may require surgery, which can be successful in alleviating symptoms and preserving kidney function.
  • Regular follow-up with a healthcare provider is essential to monitor the condition and address any potential complications, such as recurrent strictures or urinary tract infections.

It’s important to consult with a urologist or specialist who can provide tailored treatment recommendations based on the specific characteristics of the stricture.

Prevention & Management

Preventing ureteral stricture disease is not always possible, especially in cases where the condition is congenital or caused by factors beyond one’s control. However, there are steps you can take to reduce the risk of certain acquired strictures and manage the condition effectively:

Prevention:

  • Hydration: Staying adequately hydrated helps prevent kidney stones, a common cause of ureteral strictures. Drink plenty of water and maintain a balanced diet to minimize stone formation.
  • Infection Control: Promptly treating urinary tract infections can prevent inflammation and scarring that may lead to strictures.
  • Safe Practices: Minimize the risk of injury to the urinary tract during medical procedures or accidents by following safety guidelines and discussing potential risks with your healthcare provider.

Management:

  • Regular Check-ups: If you have a history of ureteral strictures or related conditions, regular check-ups with a urologist can help monitor your kidney function and identify any potential issues early.
  • Medications: Follow your healthcare provider’s recommendations for antibiotics or pain relievers to manage symptoms and prevent infections.
  • Lifestyle Modifications: Depending on the underlying cause, your healthcare provider may recommend dietary changes, such as reducing salt or certain foods, to manage the condition effectively.
  • Surgical Follow-up: If you undergo surgery for ureteral strictures, adhere to your surgeon’s post-operative instructions, including follow-up appointments and any recommended lifestyle changes.
  • Monitor for Recurrence: Be aware of the signs and symptoms of ureteral stricture recurrence, such as flank pain, blood in the urine, or urinary tract infections. Promptly report any concerning symptoms to your healthcare provider.

CONCLUSION

Ureteral Stricture Disease is a complex medical condition characterized by the narrowing or constriction of the ureters, which can lead to a range of symptoms and complications. Understanding the causes, symptoms, and available treatment options is crucial for individuals affected by this condition.

Early diagnosis and appropriate medical intervention can significantly improve the outlook for those with ureteral strictures. Whether it involves medication, minimally invasive procedures, or more extensive surgical interventions—tailored treatment plans can provide relief and help maintain kidney function.

For more information on Ureteral Stricture Disease