Ureteric stricture is a medical condition where in the lumen of the ureter narrows down and obstructs the flow of the urine. Lumen is the duct that is responsible to carry urine from the kidneys to the bladder. There are several reasons that can cause ureteric strictures. The causes are commonly categorized as either anastomotic or non-anastomotic the categorization depends on the development of the obstruction. In certain cases, the stricture might be malign while in others it is considered benign.
Ureteropelvic junction (UPJ) obstruction is the most common form of ureteric stricture which is caused when narrowing occurs at the level of the UPJ. Usually, the ureteric stricture is an outcome of kidney infections, kidney stones, or damage to the functions of the kidney.
Who Gets It?
Anyone can develop ureteric stricture, however, individuals undergoing the treatments for certain medical conditions such as ureterostomy for a kidney, or ureteric stone management of urinary diversion are at a greater risk of developing the condition. In any case, if you experience pain in your lower abdomen while urinating or other problems related to urinating, you must consult the doctor.
Causes of Ureteric Stricture
External trauma or a side effect of undergoing treatment for some other condition are the two primary causes of ureteric stricture. Some of the common causes of the conditions are listed below:
- Congenital Obstruction
- Stone Induced Stricture
- Retroperitoneal Fibrosis
- Malignant obstruction
Gonorrhea, tuberculous urethritis, or schistosomiasis can make the ureteric stricture inflammatory. Also, as a complication occurred out of cancer, the condition might become inflamed.
Ureteric stricture also differs depending upon their site of origin. The most common sites of ureteric strictures are:
- UPJ Obstruction
- Proximal Ureteral Stricture
- Pan-ureteral Stricture
- Distal Ureteral Stricture
Signs & Symptoms
The signs and symptoms of ureteric stricture are quite evident and can be easily traced. These symptoms include:
- Side or back pain.
- Feeling of fullness in the bladder.
- Blood in the urine.
- Urinary tract infection.
- Pain that worsens when alcohol or other liquids are intakes.
Depending upon the symptoms and a physical examination, the doctor may suggest one or more diagnostic procedures for ureteric stricture. The tests include:
- Nuclear medicine renal scan.
- Antegrade nephrostogram.
- Retrograde pyelogram.
- CT urogram.
There are several options available to repair ureteral stricture. The choice of treatment depends upon the location of the stricture, its causes, and any prior surgery. Here are some of the effective treatments for ureteric stricture:
- Pyeloplasty: This is effective in case of congenital ureteral obstruction at the level of the UPJ.
- Buccal Mucosal Uretheroplasty: A part of the mucosa is taken from the lining of the mouth from inside and a patch is made in the stricture region. It is a minimally invasive procedure.
- Ureteroureterostomy: In case of short stricture the surgeons remove the stricture segments completely through surgery.
- Boari Flap: The procedure involves reshaping of the bladder in case the stricture appears in the mid to lower section.
- Ureteral Reimplant with Psoas Hitch: In case the stricture is low and very close to the bladder, the doctors mobilize the bladder minimally.
Ureterolysis, stent placement, and ileal ureter are also some possible treatments for ureteric stricture.