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Ureteral stricture is an abnormal narrowing of the ureteral canal that completely or partially violates its patency. Ureter stricture is manifested by symptoms of concomitant pathological conditions: pyelonephritis, stone formation, hydronephrosis, chronic renal failure.

The disease can be both congenital and acquired. The causes of congenital ureter strictures are changes in the urinary duct due to hereditary abnormalities or its compression by nearby blood vessels. Most often, congenital stricture is formed in the area of the transition of the pelvis to the ureter or in the transition of the ureter to the bladder.

Acquired stricture of the ureter is formed when it is damaged during surgery or instrumental procedures (urethroscopy, stenting of the ureter), or is the result of urogenital infections (gonorrhea, tuberculosis), bedsores, inflammation of nearby tissues (periuteritis) and radiation damage.

The causes of stricture of the ureter

Urology refers to congenital strictures of the ureter as cicatricial changes in the duct wall due to existing hereditary abnormalities, as well as its compression at the intersection with blood vessels (for example, an additional renal vessel). The causes of acquired stricture are damage to the ureter as a result of operations and various instrumental procedures (stenting of the ureter, ureteroscopy, etc.), injuries, bedsores from stones, urinary infections (tuberculosis, gonorrhea) and inflammation of the surrounding tissues (periuteritis), radiation damage.

In tuberculosis, multiple cicatricial strictures of the ureter are formed in areas that have undergone infiltration and ulceration. Radiation strictures of the ureter are usually observed in its pelvic region and may be associated with radiation therapy for prostate, rectal, and female genital cancers. Ureteral strictures after urological surgery (ureterolithotomy, reconstruction of the pelvic-ureteral segment) can be observed in any part of the ureter.

 

Symptom of disease

Clinical symptoms of ureteral stricture are associated with a violation of the natural outflow of urine from the kidney and the subsequent formation of such pathological processes as urolithiasis, hydronephrosis, pyelonephritis, and chronic renal failure (with bilateral lesions).

As a result, symptoms characteristic of these diseases are noted:

  • acute or dull pain in the lumbar region
  • the allocation of foul-smelling turbid urine
  • reducing the amount of urine
  • increased body temperature
  • signs of General intoxication
  • nausea, vomiting
  • arterial hypertension
  • muscle cramps


Treatment of ureteral stricture

Ureteral stricture is an absolute indication for surgical treatment, the choice of which is determined by the structural and functional state of the ureters and kidneys, the length and level of stenosis. With minimal damage to the renal tissue, various reconstructive operations are performed in the corresponding part of the ureter, the purpose of which is to eliminate the narrowing of the duct, to restore the free flow of urine from the Cup-pelvic apparatus of the kidneys.

In case of serious lesions of the upper urinary tract and the development of kidney failure, the first stage of surgical treatment is open or puncture nephrostomy. Sometimes endoureteral dissection of adhesions with stent placement, buging and balloon dilation of the narrowed ureter is performed, but they do not give a lasting effect and can lead to even greater complications. Ureterolysis-surgical removal of fibrous tissue that compresses and deforms the ureters from the outside, for greater efficiency, combined with resection of the narrowed area and other reconstructive operations.

In ureteroureteroanastamosis, an oblique resection of the ureter's stricture is performed and its ends are stitched on a specially inserted catheter; in pyeloureteroanastomosis, after a longitudinal dissection of the ureter's canal (including its healthy tissues, stricture, and part of the pelvis), the walls are sewn in a transverse direction (side to side). Direct ureterocystoanastamosis is performed in the presence of a single stricture in the yukstavesical mouth, after cutting off which, the intact end of the ureter is sewn into the wall of the bladder.

The modified Boari operation (indirect ureterocystoanastamosis) is used for longer (up to 10-12 cm) strictures of the ureter, allowing the formation of a remote part of the ureter from a flap of the bladder. With stricture in the pelvic-ureter segment, a flap is created from the side wall of the renal pelvis to replace part of the ureter at the site of narrowing (Foley operation).

With extensive strictures of the ureter, partial or complete intestinal plasty of the ureter is used, in which its narrowed part is replaced with an autotransplant formed from the tissue of the intestinal wall. Intestinal ureteral plastic surgery is a fairly large operation in terms of volume and duration, which is contraindicated in seriously ill and weakened patients in the acute post-traumatic period. When ureter strictures are complicated by severe lesions of the renal tissue (polycavernous tuberculosis, hydronephrosis, pionephrosis, kidney wrinkling), nephroureterectomy (removal of the kidney and ureter) is performed.

 

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