Athletes are at a higher risk of ureteric strictures than non-athletes. While the treatment is possible, early diagnosis is crucial for successful treatment of the condition. Physical fitness is crucial for athletes, and living with strictures can affect their careers negatively. So, let’s learn all about the management of ureteric strictures in athletes, how exercise-induced ureteric stricture affects them, and how the condition is treated with endoscopic treatment of ureteric strictures in athletes. Due to the recurrent nature of this condition, it is crucial to understand the underlying cause of the condition to ensure it can be effectively treated. So, let’s take a look at some of the common causes of ureteric strictures in athletes first.

Common Causes of Ureteric Strictures in Athletes

The increased risk factor of athletes to strictures comes from their practice. Injuries can be a common cause of ureteric strictures in sports. Regularly being in practice for any type of sport increases your chances of being injured. Plus, even with minor injuries that are repeated, it can cause scarring in the ureter and cause strictures in the future. So, this is how the increased risk factor of ureteric stricture in athletes is determined. But what are the actual causes of the strictures? Let’s find out.

There are three major causes of ureteric strictures in athletes. Chronic inflammation, scarring, and repeated trauma. Any sport that has the probability of the person getting injured in their lower back and stomach is at an increased risk of the condition. Contact sports like boxing, rugby, or even field athletes are at a much higher risk of the condition than general athletes because of the repeated injuries they can sustain in their lower back and abdomen. Let’s take a closer look at the different causes and how they affect athletes.

• Chronic Inflammation: Chronic inflammation of the ureter is a common cause of ureteric stricture in athletes. In most cases, the inflammation is a result of kidney disorders and urinary tract infections. In some cases, it can even be caused due to STIs. Kidney disorders can be a common factor for athletes that need to perform in a physically demanding sport where they can be easily dehydrated. And it is also common in athletes who need to lose weight quickly to stay in shape and perform in their sport.
   
• Scarring: Scarring of the ureter is possible from injuries sustained during practice or the performance of an athlete. Especially with high-performance sports like boxing, an injury to the lower part of your body, namely the lower back or stomach, can seriously increase your risk of ureter damage. The worst part is that the scarring can happen much later, even after you have recovered from the injury. So, ureteric stricture in high-performance athletes is common.
   
• Repetitive Trauma: Repetitive trauma indicates injuries sustained during the practice and performance of the athlete’s sport. Certain sports, like boxing or rugby, are based on contact, and injuries to the lower back or stomach are common in these sports. Even if the sport is not as directly contact based as boxing, other sports can increase this risk too. Even gymnasts are at risk of athletic-induced ureteric obstructions due to the falls they have to take as a part of their training.

Management of Ureteric Strictures in Athletes

Given the higher risk of strictures in athletes, the crucial thing to do is to try and get an early diagnosis of the condition as much as possible. Given the common causes of strictures in athletes are injuries, it can lead to complex strictures. An early diagnosis is crucial for helping them with their symptoms and getting a treatment plan started. 

Given the recurrent nature of the condition, early diagnosis also helps mitigate the risks of recurrence and can ensure the athlete can go back to their profession without any problems. Management of the condition relies heavily on identifying the symptoms and using that understanding to get an early diagnosis. So, let’s understand the various symptoms of ureteric strictures and how the condition is diagnosed by doctors.

Symptoms of Ureteric Strictures in Athletes

The symptoms of ureteric strictures can differ slightly based on the root cause of the condition. Here are some of the most common and important ureteric stricture symptoms for athletes.

• Flank Pain: Pain in your lower back or abdomen is one of the most common symptoms of strictures. However, strictures can’t be diagnosed with this one symptom alone. It is generally one of the telltale symptoms that something is wrong with your urinary system. Post-injury, if athletes are experiencing sharp or dull constant pain in their lower back or abdomen, that needs medical attention.
   
• Inflammation in your lower extremities: Inflammation in the legs combined with flank pain, can be an important symptom of ureteric strictures. The inflammation is caused due to urinary obstruction caused by the stricture. The inflammation can gradually increase so it’s important to keep a check on your legs, feet, and even hands.
   
• Recurrent Urinary Tract Infections: Urinary tract infections are common when there is some type of obstruction hindering urine flow. That is why recurrent UTIs matched with the previously mentioned symptoms, can be a clear indication of ureteric strictures. Additionally, UTIs can also cause recurrence of the strictures even after treatment. So, it is crucial that you find the root cause of the infections and get it treated along with your ureteric stricture treatment.
   
• Increased Urinary Frequency: Urinary frequency matched with flank pain or inflammation in your legs can indicate ureteric strictures. Increased urinary frequency in the case of ureteric stricture is often caused due to a narrow ureter, which puts pressure on the bladder. So, urinary frequency is one of the early and crucial symptoms of strictures.
   
• Hematuria: Hematuria combined with the other symptoms mentioned is the absolute telltale symptom of ureteric stricture. Blood in your urine combined with the other symptoms directly point towards strictures showing that the condition has developed into an advanced stage. It is crucial that you get medical treatment as soon as possible at this point. Also, if you have a majority of the symptoms mentioned above, it also points towards ureteric strictures, so be mindful of your symptoms and get help.

Diagnosis of Ureteric Strictures in Athletes

Invasive procedures are a risk factor for strictures so for athletes at least, invasive procedures are tried and avoided as much as possible. It ensures that they are not exposed to more risks in the process of diagnosing. Some of the most common non-invasive diagnostic tests used are:

• X-Rays: X-rays are very effective non-invasive tests that are used to diagnose ureteric strictures. A special dye is inserted into the urinary tract to get a contrast that can be used to easily locate the stricture and understand its length and location. This process is quick and painless, making it one of the most common imaging tests used for diagnosing strictures.
   
• Urinalysis: Studying the composition of urine can give doctors a thorough understanding of the urological system of the body. Using urinalysis doctors check for the presence of certain elements in the urine. If they are present, it can indicate ureteric strictures. Urinalysis and certain blood tests are commonly used to diagnose this condition.
   
• CT Scan: CT Scans are used in case X-rays don’t get a clear enough image of the stricture. CT Scans are more powerful and can generate a clearer image of the stricture, which is crucial in deciding upon the treatment options. The same procedure as X-rays can also be used in the CT scans with a contrast medium used to see the stricture clearly.

These diagnostic tests are crucial in helping doctors understand the severity of the stricture, its size, and its location. Though ureteric strictures can be treated with medicines in some cases, doctors often recommend surgical treatment of ureteric obstruction in athletes because they offer relief from the symptoms quickly and have a shorter recovery. Let’s take a look at the common ureteric stricture surgeries recommended by doctors.

Surgical Treatment of Ureteric Obstruction in Athletes

Surgical treatment of ureteric obstructions is some of the most effective ways to treat ureteric strictures. There are a number of procedures that are suggested to patients based on the severity of their stricture and the symptoms they are currently showing. Also, you should remember that surgeries are a risk factor for stricture recurrence. So you should get your procedure done from institutions that have the experience and required infrastructure to ensure you are not at a higher risk after surgery. Choosing experienced institutions like MASSH can be your key to getting rid of your ureteric strictures forever. With that being said, here are some of the most commonly used procedures used to treat ureteric obstructions in athletes.

Balloon Dilation

Balloon dilation is one of the easiest surgical treatments for ureteric strictures. This procedure is quick and works much like a balloon angioplasty. Only difference is, it operates on your ureter and no incisions are made into your body. The scope and the balloon are inserted into the body through the urethra and sent into the ureter through the bladder. Once the visuals confirm that the balloon is at the stricture, it is inflated to clear the ureter and allow for clear passage of urine.

This procedure is performed on an outpatient basis and patients can even go home the very same day. Balloon dilation is very effective in treating small strictures, however, given how easy and safe this procedure is, doctors might recommend multiple dilations. This is done in case the strictures are larger than 1 cm or there are multiple strictures in the ureter.

Stent Placement

Stent placement is a temporary treatment option for ureteric strictures, mainly because the stents need to be removed from the body at some point. When the stents are removed, the strictures can return. However, as long as they are inside the body, they are perfectly capable of keeping your strictures in control.

Stents are inserted through the urethra in a minimally invasive procedure where no incisions need to be made inside the body. Based on the size of the stricture, custom stents are made from biocompatible materials that won’t harm the human body in any way. Generally, stent placement is combined with other medicinal treatments to ensure the strictures can be cleared out naturally before the stent is removed.

Ureterorenoscopy

Ureterorenoscopy is the one of the most successful treatment processes for ureteric strictures and it is also one of the only permanent treatment options for the condition. Getting this procedure ensures that you won’t be strictures again in the future. The procedure is more elaborate than the previous options and comes with certain risks, but if you get from an experienced institution like MASSH, the risks are negligible.

The procedure is performed under general anesthesia where doctors insert the surgical tools and a camera scope through the urethra of the patient. Once it reaches the stricture in the ureter through the bladder, the surgical tools can be used to cut the stricture out completely or vapourize it using a laser. This procedure is very precise and doesn’t harm the surrounding tissues. In certain cases, if the stricture is too large, doctors graft oral tissues in its place to keep the ureter functioning normally.

Percutaneous Ureterorenoscopy

Percutaneous ureterorenoscopy is very similar to ureterorenoscopy except in this procedure incisions are made into the back of the patient to access the ureter from the outside. This procedure is prescribed in advanced cases of ureteric strictures. A single long incision is made into the back of the patient to get visuals on the ureter. The surgery is continued using surgical tools or lasers to cut out or vapourised.

Since this surgery is complex, it has a longer recovery time, but it is a permanent treatment option for ureteric strictures. Doctors can keep you admitted in the hospital for a few days after the surgery to monitor your recovery. And once you are home, you must follow certain post-operative care instructions to ensure your health is back on track without the fear of recurrent strictures.

Conclusion

Athletes are needed to stay in the best shape possible and sometimes that requires being informed about conditions they can possibly be affected by and their symptoms. So, if you are an athlete and are facing any of the symptoms discussed in this article, feel free to visit us today at MASSH. We are experts in all things urology and can help you get the necessary treatment for your condition. Our team of doctors are highly trained and qualified in performing all types of surgical treatments for ureteric stricures. So, make sure you visit us soon and get a permanent solution for your urological health problems.