Ureteral stricture treatment
Ureteral stricture is a condition when the ureter narrows. It is characterised by urine accumulation in the kidney and part of the ureter. Strictures cause discomfort and severe complications in the later stages. Usually, the best treatment option is a surgical operation.
Ureteral stricture (also called stenosis) is a defect in the ureter that results in urine concentration above the narrowed area.
The kidney produces urine, which flows down to the bladder. But if there is a blockage in the urinary tract, it interferes with the urine flow. As a result, urine remains in the kidney (hydronephrosis), which leads to increased pressure and progressive damage to the kidney.
Because of the longer urethra, men are more likely to develop urethral strictures. It is rare in females. Statistics show that 0.2% to 0.6% of men suffer from this disorder.
The narrowing of the ureter has various forms:
- Thickened walls of the ureter;
- Bending of the ureter;
- Squeezing by vessels;
- Protrusion of the ureter (diverticulum).
It is a dangerous condition leading to frequent urinary tract infections, kidney stones and, in the worst case, kidney failure.
What can be the cause of ureteral stricture?
The causes can be both congenital and acquired. Ureteral stricture might be a congenital disability. Other hereditary reasons may be additional vessels in the ureter. Common causes of a ureteral stricture include:
- Sexual infections;
- Bedsores from stones;
- Scars of the ureter;
- Complications after medical manipulations (catheterisation or endoscopy);
- Tumours (benign prostatic hyperplasia or prostate cancer; cancer of the uterus or ovaries, colon).
Other reasons are urethritis (inflammation) or ureteral cancer. Radiation damage is also a stricture explanation, for example, after radiotherapy for prostate cancer (in men) and cancer of the uterus or ovaries (in women).
The ureteral stenosis remains unnoticed for a long time until the lumen of the urethra decreases significantly. Then patients complain of the following signs:
- Low back pain (intermittent and dull or acute attacks);
- Swelling of the lower extremities;
- Double stream of urine;
- Blood in the urine;
- High blood pressure;
- Urinary retention, incomplete emptying of the bladder);
- Nausea and vomiting;
- Weakness and weight loss.
How do doctors diagnose ureteral narrowing?
To diagnose ureteral stricture, doctors conduct a comprehensive examination, including imaging methods of the urinary tract. If a stricture is suspected, the urologist performs urography with contrast. It uses x-rays to examine kidney function, area, length, degree of narrowing, and its causes (tumour, cyst, stone).
Renal ultrasound will help assess the shape and size of the kidneys and the place of narrowing.
Computed tomography or magnetic resonance imaging is a more accurate technique that visualises the urine flow and shows the reason for the narrowing (tumours, metastases, developmental anomalies, inflammation, thrombosis, and others).
In addition to the methods listed above, additional blood and urine tests are helpful.
Ureteral stricture treatment depends on the underlying cause. Doctors prescribe medications to relieve symptoms, for example, antibiotics, anti-inflammatories, and painkillers.
Surgery is usually required to clear a blockage in the outflow of urine. Operation options include:
- Urethral dilation (expansion) with balloons or stents;
- Urethroplasty (urethral reconstruction in the case of bends, protrusions and others);
- Removal of the affected part of the ureter;
- Nephrectomy is the kidney removal with the ureter (if complications occur).
An alternative is a percutaneous nephrostomy, in which a tube is passed directly into the kidney and drains urine.
What can patients with ureteral narrowing expect?
In general, the prognosis for ureteral stricture is good. However, treatment success depends on many factors and is 50-75% for balloon dilatation, more than 80% for stent placement and more than 90% for urethroplasty.
What is the best treatment for ureteral stricture?
The best treatment for ureteral stricture is surgery. Most often, this is the reconstruction of the ureter. However, depending on the cause, doctors may perform other types of surgery, such as balloon dilatation, ureteral stenting, or removal of the affected ureter.
Can I treat ureteral stricture without surgery?
No. Non-surgical treatment is an adjunct to surgery. Therapy with drugs reduces the symptoms of the disease. General medical recommendations are also used in addition to the operation.
Do patients with ureteral stricture travel for treatment abroad?
Yes. Many patients with ureteral stricture prefer treatment abroad. They are attracted by many years of doctors' experience and the latest low-traumatic treatment methods.
What doctor should I check for ureteral stricture?
Urologists deal with the treatment of the stricture of the ureter. In addition, they are specialists in diseases of the genitourinary organs, ranging from the kidney to the bladder, as well as the prostate and testicles in men.
What departments can be responsible for ureteral stricture?
The urology department is usually responsible for ureteral strictures. Since urology is a surgical speciality, patients do not have to move to several departments. Instead, they are located and undergo treatment in a single place.
Where can I get Ureteral stricture treatment?
What are the best clinics for Ureteral stricture treatment?
Who are the best doctors for Ureteral stricture?
Prof. Dr. med. Jurgen Gschwend from University Hospital rechts der Isar Munich
Prof. Dr. Torremade Barreda Josep from Teknon Medical Centre Barcelona
Dr. Luis Garcia Aparicio from Teknon Medical Centre Barcelona
Prof. Dr. med. Martin Kriegmair from Urological Clinic Munich-Planegg
Prof. Dr. med. Laszlo Kovacs from Urological Clinic Munich-Planegg