Urethral and ureteral strictures
What is it?
Ureteral stenosis is a reduction in the caliber of the ureter, the tubular structure that carries urine produced by the kidneys to the bladder. This reduction causes an obstacle to the physiological flow of urine causing dilation of the upper urinary tract proximal to the stenotic segment and complications such as infection, stones, loss of renal parenchyma and even renal failure. Ureteral stenosis can be congenital or acquired. Congenital stenoses appear to be due to an embryogenetic defect. Multiple stenoses can occur throughout the ureter, but generally such pathology most frequently affects the distal ureter and then the pyelo-ureteral junction and, very rarely, the intermediate tract. Acquired ureteral strictures, on the other hand, are more frequently of iatrogenic origin (following ureteroscopy, catheterization, gynecologic or pelvic surgery on the ureter, radiotherapy) and more frequently affect the distal part of the ureter.
Which are the symptoms?
The most frequent symptoms are flank pain, episodic and usually exacerbated by increased fluid intake, renal colic if secondary stones are present at the same time, urinary tract infections, hypertension related to renal parenchyma loss.
- flank pain
- kidney colic
- urinary tract infection
- high blood pressure
How is it diagnosed?
Antenatal ultrasound allows early identification of possible ureteral stenosis. Even in young adulthood, ultrasound of the urinary tract is the first-line diagnostic method.
If a ureteral stenosis or an ultrasound-assessable ureter is identified, one or more of the following diagnostic tests are performed:
CT scan of the abdomen with contrast medium and/or ascending pyelography that allow to evaluate the length of the stenosis is decisive for the correct choice of therapy.
Renal scintigraphy: allows to study renal function.
Ureteroscopy: allows direct visualization of the stenotic tract.
Suggested exams
How is it treated?
Treatment of ureteral stenosis should be appropriate for the type of stenosis and the condition of the patient. The therapeutic possibilities are mainly surgical. Depending on the case, the treatment can include ureteral plastic surgery in which the stenotic ureteral tract is removed and the continuity of the ureteral stumps is restored, and ureteral re-implantation surgery in case of low ureteral stenosis in which the stenotic ureteral tract is resected and the healthy ureter is re-implanted on the bladder. These interventions can also be performed by robotic technique in order to minimize the invasiveness of the intervention and allow the execution of extremely refined sutures in view of a maximum reduction of the risk of subsequent recurrence of the stenosis. In the presence of stenosis not tight and not large, it is possible to try an endoscopic treatment that involves the incision of the stenosis with laser and the subsequent dilation of the same with a balloon, followed by the placement of a ureteral stent for at least a couple of months.
Where do we treat it?
Are you interested in receiving the treatment?