How does balloon dilatation work?
Through the urethra and bladder at the mouth of the ureter, under X-ray control, a guide is passed through the stricture, along which a balloon catheter is installed, which is installed exactly in the area of narrowing and inflated with diluted contrast for 3–5 minutes; The image monitors the disappearance of the “waist” of the balloon. Sometimes dilatation is supplemented with laser dissection of the scar (endoureterotomy). A larger diameter stent is then placed for 4–6 weeks. The balloon evenly stretches the stricture, which is less traumatic than bougienage and gives better results with loose narrowings.
Causes and signs of ureteral stricture
Narrowing of the ureter develops after trauma during stone removal, radiation therapy, surgery on the pelvic organs, tuberculosis, long-term stone retention; congenital strictures occur in the ureteropelvic segment. Manifested by hydronephrosis, dull pain in the lower back, infections, decreased kidney function. The diagnosis is made by MSCT urography and retrograde ureteropyelography, renal function is assessed by scintigraphy.
Endoscopic treatment or plastic surgery
Bougienage and balloon dilatation are minimally invasive methods for short (up to 1–1.5 cm) loose strictures without severe ischemia: effectiveness is 50–70%, recovery is fast, but relapses are frequent. For extended, dense, radial and recurrent strictures, reconstructive surgery is indicated - ureteroureteroanastomosis, ureterocystoneoanastomosis or pyeloplasty with an effectiveness of 85–95%. The endoscopic method can be tried first if kidney function is intact.
