Ureteral stricture is 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 expand significantly due to its elastic wall. In contrast, with stricture of the ureter, fibro-sclerotic changes occur that affect 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 with scar tissue, hypertrophy of transverse muscle fibers, and 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 disruption 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) are 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 into the bladder) and pyeloureteral (transition of the pelvis into the ureter) sites. The true stricture of the ureter 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 extent 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 pyelocaliceal apparatus of the kidneys.
In case of 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 is performed with the installation of a stent, bougienage and balloon dilatation of the narrowed ureter, 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, is combined with resection of the narrowed area and other reconstructive operations.
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