Ureteral stricture disease
Ureteral stricture disease is a condition where the ureter, the tube that carries urine from the kidneys to the bladder, becomes narrowed or blocked. This can result from injury, infection, inflammation, or previous surgeries. Symptoms may include pain, urinary tract infections, and difficulty urinating. Treatment depends on the severity and location of the stricture and may involve methods like balloon dilation, stent placement, or surgical reconstruction of the ureter. In some cases, a kidney may become damaged if the blockage is left untreated, so early diagnosis and management are essential to preserve kidney function.
Ureteral stricture disease is a condition where the ureter, the tube that carries urine from the kidneys to the bladder, becomes narrowed or blocked. This can result from injury, infection, inflammation, or previous surgeries. Symptoms may include pain, urinary tract infections, and difficulty urinating. Treatment depends on the severity and location of the stricture and may involve methods like balloon dilation, stent placement, or surgical reconstruction of the ureter. In some cases, a kidney may become damaged if the blockage is left untreated, so early diagnosis and management are essential to preserve kidney function.
Treatment
Ureteral Stent Placement:
A common initial treatment involves placing a silicone tube, known as a ureteral stent, extending from the kidney to the bladder to maintain urine flow. This procedure, called retrograde ureteral stent placement, is often the first recommendation by doctors. It's important to note that ureteral stents are not permanent and must be replaced every three to four months to prevent complications such as stone formation and obstruction.
Balloon Dilation:
This minimally invasive procedure involves inserting a balloon catheter into the narrowed section of the ureter and inflating it to widen the stricture. Following dilation, a stent is typically placed for 4 to 6 weeks to ensure the ureter remains open.
Endoureterotomy:
In this procedure, a specialized instrument is used to make an incision in the stricture to enlarge the narrowed area. Techniques such as holmium laser endoureterotomy have been utilized as minimally invasive alternatives to open surgery.
Ureterolysis:
For strictures caused by external compression, such as retroperitoneal fibrosis, ureterolysis may be performed. This surgical procedure involves freeing the ureter from surrounding fibrous tissue. Initial treatment may include a course of steroids with stenting to reduce inflammation and relieve obstruction. If steroids are ineffective, ureterolysis becomes necessary.
Surgical Reconstruction:
In cases where minimally invasive methods are unsuccessful or not feasible, surgical reconstruction may be considered. Options include laparoscopic or robotic-assisted surgery to repair the stricture, aiming to provide a permanent solution and avoid long-term stent use.
Considerations:
The choice of treatment depends on factors such as the stricture's location, length, cause, and the patient's overall health.
Regular follow-up is essential to monitor the success of the treatment and to detect any recurrence of the stricture.