Why does a stricture form?
The wall of the ureter is thin and sensitive to damage. When its mucous membrane is injured - by a stone, instrument, inflammation or radiation - a scar is formed at the site of the defect. Scar tissue does not stretch and gradually contracts, narrowing the lumen.
The outflow of urine is disrupted, pressure in the overlying sections increases, and hydronephrosis develops. In this case, the kidney suffers silently: there may be no pain at all, because the expansion occurs slowly and the kidney capsule has time to adapt.
Reasons
- Prolonged presence of a stone in the ureter is one of the most common causes
- Consequences of endoscopic interventions: ureteroscopy, contact lithotripsy
- Complications after operations on the pelvic organs, including gynecological and coloproctological
- Radiation therapy of the pelvic organs
- Chronic inflammation, tuberculosis of the genitourinary system
- Retroperitoneal fibrosis
- Compression from the outside by a tumor, lymph nodes, or vessel
- Congenital narrowings, including the ureteropelvic segment
- Ischemia of the ureter after prolonged placement of a stent or nephrostomy
- Injuries
Symptoms
- Often there are no symptoms - finding on ultrasound
- Dull aching pain or heaviness in the lower back on the affected side
- Increased discomfort after drinking large amounts of liquid
- Recurrent urinary tract infections and pyelonephritis
- Increased blood pressure
- Blood in urine
- With bilateral damage - weakness, swelling, decreased urine volume
- Attacks resembling renal colic, with complete occlusion
Diagnostics
- Ultrasound of the kidneys - reveals the expansion of the collecting system
- CT urography with contrast - determines the level, length of the narrowing and its cause
- Retrograde ureteropyelography - accurate visualization of the extent of the stricture before surgery
- Antegrade pyelography through a nephrostomy
- Dynamic nephroscintigraphy - assessment of the preservation of kidney function, a key parameter for choosing tactics
- Ureteroscopy - direct examination and, if necessary, biopsy
- Creatinine, general analysis and urine culture
- MRI or CT scan of the abdomen if external compression and retroperitoneal fibrosis are suspected
Two parameters determine everything: the length of the stricture and the preservation of kidney function. A short narrowing with a working kidney is treated endoscopically; extended requires reconstruction, and lost function may change the decision in favor of organ removal.
Treatment
- Ureteral stenting - rapid restoration of outflow, often as the first stage
- Percutaneous nephrostomy - for infected obstruction or inability to place a stent
- Balloon dilatation of a stricture - expansion of the narrowed area with a balloon; effective for short contractions
- Bougienage of ureteral stricture
- Endoureterotomy - dissection of the scar from the inside
- Ureterocystoneoanastomosis - transplantation of the ureter into the bladder when the lower third is affected; open or laparoscopic
- Operation psoas hitch and Boari flap for extended defects of the lower third
- Pyeloplasty for stricture of the ureteropelvic segment
- Uretero-ureteroanastomosis for short defects of the middle third
- Nephrectomy - with complete loss of kidney function and complications
Observation after treatment
- Control ultrasound within the time prescribed by the doctor - the dilation of the pelvis does not decrease immediately
- Timely removal or replacement of the stent; an expired stent becomes overgrown with salts and creates obstruction itself
- Dynamic scintigraphy for objective assessment of outflow
- Monitoring creatinine and blood pressure
- Urinalysis for any signs of infection
- Observation for several years: recurrence of stricture is possible even after a long time
Where is ureteral stricture treated in Tashkent
Treatment requires a full range of options: from stenting and balloon dilatation to laparoscopic and open ureteral reconstruction.
In Tashkent, such interventions are performed at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you have ever had a stone in the ureter or surgery on the urinary tract, and ultrasound shows dilation of the pelvis, do not delay the visit, even if there is no pain. In this condition, time works against the kidney. Clinic contacts are below.
