Oral stenosis: when to dissect
Narrowing of the mouth leads to expansion of the ureter and pelvis, attacks of pain, and infections; it is often detected when the ureteroscope cannot be passed into the ureter. The dissection is performed along the upper wall of the orifice over a short distance so as not to cause reflux; if a stone is wedged, it is simultaneously removed. A stent is installed for 2–4 weeks. Efficiency 85–95%; in case of extensive stenosis of the intramural region, reimplantation of the ureter is indicated.
Ureterocele and ostial stenosis
Ureterocele is a congenital cystic dilatation of the intravesical ureter due to a narrow orifice; it interferes with the flow of urine, causes hydronephrosis, infections and stones, and a large ureterocele can block the neck of the bladder. Stenosis of the ureteral orifice also occurs after TUR, radiation therapy, tuberculosis, or long-term presence of a stone in the orifice. In both cases, endoscopic dissection restores outflow.
After surgery
The patient spends 1–2 days in the hospital; if a stent is installed, it is removed after 2–4 weeks. The main risk after dissection of a ureterocele is vesicoureteral reflux, so the incision is made minimal and in the lower part, and after 3 months a control cystography is performed. If reflux persists or the upper half of the double kidney is nonfunctioning, ureteral reimplantation or heminefroureterectomy is discussed.
