Ureteral stricture - an abnormal narrowing of the ureteral canal, completely or partially disrupting its patency. Ureteral stricture is manifested by symptoms of concomitant pathological conditions: pyelonephritis, stone formation, hydronephrosis, chronic renal failure.
The normal anatomical and physiological narrowing of the ureter, if necessary, can significantly expand due to its elastic wall. In contrast, with a stricture of the ureter, fibro-sclerotic changes occur, affecting the submucosal, muscular and outer layers of the ureter wall. In turn, this leads to atrophy of some of the muscle elements and their replacement by scar tissue, hypertrophy of the transverse muscle fibers, as well as changes in the innervation of the wall.
As a result, in the area of the stricture, there is a persistent decrease in the diameter of the excretory duct, leading to a violation of the normal function of the ureter. In areas above the stricture, due to stagnation of urine, pressure on the ureter increases, its stretching, elongation and tortuosity are observed, expansion of the pelvis and the development of hydronephrosis (ureterohydronephrosis) is possible.
Strictures can occur in different parts of the ureter and have different lengths. Most often, strictures are observed in the juxtavesical (transition of the ureter to the bladder) and pyeloureteral (transition of the pelvis into the ureter) sites. True ureteral stricture by origin is congenital and acquired. Ureteral strictures can be unilateral and bilateral, single and multiple, true (due to changes affecting the wall) and false (due to external compression).
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 of the corresponding section of the ureter are performed, the purpose of which is to eliminate the narrowing of the duct, to restore the free outflow of urine from the renal pyelocaliceal apparatus.
With serious lesions of the upper urinary tract and the development of renal failure, the first stage of surgical treatment is open or puncture nephrostomy. Sometimes endoureteral dissection of adhesions with placement of a stent, bougienage and balloon dilation of the narrowed part of the ureter is performed, but they do not give a lasting effect and can lead to even greater complications. Ureterolysis is a surgical removal of fibrous tissue compressing and deforming the ureters from the outside; for greater efficiency, it is combined with resection of the narrowed area and other reconstructive operations.
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