Ureteral strictures are narrowings in the ureter, the muscular tube that carries urine from the kidney to the bladder. These constrictions can partially or completely block the flow of urine, leading to discomfort, infection, or even kidney damage if left untreated. Strictures may occur anywhere along the ureter and can vary in length and severity.
Symptoms of Ureteral Strictures
Symptoms often mimic other urinary tract issues and may include:
- Flank or abdominal pain, typically on one side
- Recurrent urinary tract infections (UTIs)
- Blood in the urine (hematuria)
- Decreased urine output or difficulty urinating
- Nausea and vomiting in cases of severe blockage
- Signs of kidney dysfunction, such as fatigue or fluid retention
Causes and Risk Factors
Ureteral strictures can be congenital or acquired. Common causes include:
- Surgical Injury: Strictures may develop after pelvic or abdominal surgeries, including procedures on the colon, uterus, or prostate
- Radiation Therapy: Especially for pelvic or abdominal cancers
- Chronic Inflammation or Infection: Recurrent UTIs, tuberculosis, or schistosomiasis
- Kidney Stones: Trauma from stone passage or prior stone removal procedures
- Ureteroscopy or Stenting: Scar tissue may form after instrumentation
- Cancer or External Compression: Tumors pressing on or invading the ureter
Diagnosis
Early and accurate diagnosis is essential to prevent kidney damage. Evaluation typically includes:
- Imaging Studies: CT urography, renal ultrasound, or MRI to assess kidney function and locate the obstruction
- Retrograde or Antegrade Pyelography: Contrast dye is used to visualize the stricture directly
- Nuclear Renal Scan: Measures kidney function and evaluates the degree of obstruction
- Urinalysis and Blood Tests: To check for infection, inflammation, or kidney impairment
Treatment Options
Treatment depends on the location, length, and severity of the stricture, as well as kidney function and overall health.
- Balloon Dilation or Endoureterotomy: Minimally invasive options that use a scope to stretch or incise the narrowed area
- Ureteral Stenting: A temporary solution to keep the ureter open while planning definitive treatment
- Ureteral Reconstruction: Surgical repair using ureteral reimplantation, ureteroureterostomy, or use of tissue grafts (e.g., buccal mucosa)
- Robotic or Laparoscopic Ureteroplasty: Offers precision repair with smaller incisions, less pain, and faster recovery
- Nephrostomy Tube Placement: May be used temporarily to relieve pressure if urine flow is severely blocked
Next Steps
Ureteral strictures should be addressed promptly to avoid long-term complications like kidney damage or infection. If you are experiencing persistent flank pain, recurrent UTIs, or unexplained changes in urination, consult a urologist. A customized treatment plan can restore urinary flow, relieve symptoms, and protect kidney function.