ureters

ureteric stricture disease

Ureters are essential muscular tubes connecting the kidneys to the bladder, serving as conduits for the transport of urine from the kidneys for eventual excretion. These ducts, approximately 25-30 centimeters in length, play a crucial role in regulating fluid and electrolyte balance through the controlled passage of urine. The smooth muscle fibers within the ureters generate peristaltic contractions, facilitating the efficient movement of urine. Ureteral obstructions, often attributed to factors like kidney stones, can lead to complications and necessitate medical intervention. The ureterovesical junction, where the ureter meets the bladder, is a critical juncture, and any abnormalities in this area can impact urine flow, contributing to various urinary issues.

PUJ obstruction, or ureteropelvic junction obstruction, is a condition characterized by the narrowing or blockage of the connection between the renal pelvis and the ureter, potentially hindering the normal flow of urine from the kidney.

ureteric stricture (obstruction)

Ureteric stricture disease is a medical condition characterized by the narrowing of the ureter, the muscular tubes connecting the kidneys to the bladder. This constriction can impede the normal flow of urine, leading to various complications. Causes of ureteric strictures include:

  • Inflammation: Chronic inflammation of the ureter, often due to conditions like urinary tract infections or kidney stones, can contribute to the development of strictures.

  • Trauma: Physical trauma, such as injury or surgery involving the urinary tract, may lead to scarring and narrowing of the ureter.

  • Radiation Therapy: Exposure to radiation, especially during cancer treatment targeting the pelvic area, can result in ureteral strictures.

  • Congenital Factors: Some individuals may be born with anatomical abnormalities or congenital conditions that predispose them to ureteric strictures.

  • Tumors: The presence of tumors, either benign or malignant, in or around the ureter can cause compression and narrowing, leading to strictures.

Ureteric stricture disease requires medical evaluation and, depending on the severity, may be managed through various interventions, including minimally invasive procedures or surgery, to restore normal urine flow.

the symptoms

Symptoms of ureteric stricture vary based on severity.

  • Seek medical evaluation if unsure about symptoms.

  • Examples of symptoms include:

    • Flank pain

    • Abdominal pain

    • Nausea and vomiting

    • Infection

    • Fever

What happens after referral

After receiving your referral, our practice nurse will triage your case, and you'll be promptly contacted for a brief overview of your condition. Preceding your visit, several diagnostic tests, including urine analysis, urine cytology, ultrasound, CT scan, and nuclear medicine test called MAG3, are arranged to enhance the evaluation. At your appointment, A/Prof Homi Zargar will engage with you, conduct a thorough assessment, and review the gathered information. A personalized care plan addressing your symptoms will be devised, ensuring all your questions are addressed.

Diagnosis of ureteric stricture involves:

  • A comprehensive symptom assessment through a detailed history.

  • Urologists conducting examinations and ordering additional investigations, including t

  • Midstream urine test to rule out infection or blood.

  • Imaging Studies:

    • Ultrasound: Non-invasive imaging to visualize the kidneys and ureters.

    • CT Urography (CVU): Contrast dye injected intravenously to enhance X-ray images of the urinary system.

    • Ureteroscopy: direct visualization of the ureter using a thin, flexible scope.

    • Biopsy: tissue sample analysis to identify potential malignancies.

      • If any malignancy is identified, the treatment algorithm changes significantly.

Treatment options

  • Individualized Approach: Recognizing the uniqueness of each case, A/Prof Homi Zargar tailors treatments specifically for your conditions and symptoms arising from benign prostatic hyperplasia (BPH).

  • Diverse Solutions: We provide an array of medical and surgical treatments, understanding that enlarged prostates vary, steering clear of a uniform approach.

Non-Surgical Treatments:

  • Can be considered in a poorly functioning kidney and a non-symptomatic patient

Surgical Treatments:

  • The choice of surgical option depends on the location, length, and complexity of the ureteric stricture.

  • Distal strictures often necessitate re-implantation, while proximal strictures may require pyeloplasty.

  • Ureteroureterostomy is suitable for short, localized strictures.

  • Graft procedures utilizing buccal mucosa or appendix are reserved for extensive and challenging strictures.

  • Stenting may serve as both a diagnostic tool and a temporary solution, particularly in cases where definitive surgery is delayed.

  • Stenting and endoscopic options :

    • Description: This minimally invasive procedure involves using a ureteroscope to visualize and incise the stricture, restoring normal ureteral diameter. Placement of a tube-like stent within the ureter to maintain patency and promote stricture healing.

    • Suitability: Temporary relief for proximal and distal strictures; may serve as a bridge before definitive surgical intervention.

  • Pyeloplasty:

    • Description: Focused on treating ureteropelvic junction (UPJ) strictures (also called PUJ obstruction) , pyeloplasty involves reconstructing the junction between the renal pelvis and ureter to alleviate the obstruction.

    • Suitability: Ideal for proximal ureteric strictures affecting the connection between the kidney and the ureter.

    • Read more about robotic pyeloplasty

  • Ureteric Re-implantation:

    • Description: This procedure involves detaching the ureter from the bladder and reattaching it at a different location to bypass the stricture.

    • Suitability: Typically used for distal ureteric strictures where re-implantation can provide a new route for urine flow.

  • Ureteroureterostomy

    • Description: The disease segment of the ureter is removed, and the ureter is joined back together over a stent.

    • Suitability: Effective for short and localized strictures, particularly those in the mid or distal ureter.

  • Buccal Mucosa and Appendix On-lay Graft:

    • Description: In cases where direct repair is challenging, grafts from buccal mucosa (lining of the cheek) or appendix are used to augment the ureter, improving its caliber.

    • Suitability: Useful for complex strictures involving longer segments where direct repair may not be feasible.

  • Read more about ureteric reconstruction surgery.

  • Nephrectomy is reserved for a symptomatic stricture in the setting of a poorly functioning kidney.