Treatment of Ureteral Stricture

About the disease

Ureteral stricture is a disease, whereby ureter becomes narrow as a result of previous surgeries, scarring, ureteral stones, various infections or ureteral cancer. Ureteral stricture can also be caused by hydronephrosis, which is an urine flow obstruction from the kidneys. Certain bladder diseases can also cause ureter to become narrowed. Previous ureter surgeries, such as ureteroscopy, can have such complications as ureteral stricture. Ureteral stricture develops very gradually and can be latent for a period of several months before it manifests itself. The main manifestation of ureteral stricture is inability to urinate properly as the urine flow becomes extremely obstructed. In progressed cases, a person may spend hours trying to fully urinate. Urination is also accompanied by pain and in some cases - by blood in the urine.

Ureteral stricture is more common in men. It can be explained by the fact that male`s ureter is more exposed to different infections and injuries. Almost 70% of all men with ureteral stricture previously had sexually transmitted infections, fractures or injuries, which left scar tissues in ureter.   

Symptoms

• Reduced volume of urine
• Dark urine or urine with blood
• Blood in the semen
• Incontinence
• Pain in the lower abdomen
• Sudden urges to urinate accompanied by pain

Diagnosis

• An ultrasound of an ureter is usually enough to determine if a person has ureteral stricture. Ultrasound of the kidneys is also used to see if the underlying cause for ureteral stricture was hydronephrosis. Renal and abdominal ultrasound are used to rule out other causes for ureteral stricture.
• An intravenous urography allows the doctor to examine ureter of a patient more closely and determine the extent of ureteral stricture and to see if ureter obstructs bladder and organs of reproductive system.
• A blood test and urinalysis is used to determine is a person has infection, which could have caused similar to stricture symptoms. 

Treatment

• Bougienage is a surgery, during which a special bougie, which is a cylinder device, is inserted into urethra to widen and expand urethra. Bougie can be metallic or plastic. A doctor usually determine which type of bougie is the most preferable for an individual patient.
• Transurethral splint is a surgery, when special custom-made splint is inserted into urethra to widen stricture and normalize urination process.  
• Resection with reconstruction is a radical surgery, whereby a doctor resects ureter and reconstructs it, so that a person can carry out urethral function in future.
• Endoscopic urethrotomy uses stenting after stricture was resected. Such stent keeps ureter open and prevents further stricture in future. Sometimes, this surgery is used after balloon dilation of an ureter.  

Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko