Conditions like urinary tract obstruction and kidney damage are common in the elderly age group. However, serious conditions like urinary tract obstruction or worse, kidney failure does not occur suddenly. There are symptoms of kidney failure that patients who are suffering from the condition will be able to notice much earlier. One such condition is ureteral stricture and with symptoms like pain or difficulty while peeing, or blood in the urine, a person will be able to detect first and then diagnose after visiting a urologist. 

But how common is elderly ureteric strictures? Does age contribute to a person’s chances of developing ureteric stricture? No, age alone has no effect on a person’s risk of developing ureteric stricture. However, age-related ureteric stricture can develop due to conditions one develops with age. 

In the following section of this piece, you will learn about factors and conditions that cause ureteral strictures in older adults, the symptoms that can help you identify the condition, and the treatment processes available. Knowing the conditions that contribute to the factor can help you diagnose a stricture and prevent further kidney damage and/or kidney failure.

Possible Causes Behind Ureteric Stricture in Older People
 

Changes That Occur in Tissue Elasticity

As you age, the ability of your tissues to expand and contract as per the movements of your body reduces. It only gets worse with age and happens even with the tissues of your ureter. Over time, as tissue elasticity reduces, the tissues in your ureter don’t have the ability to expand or contract in the same way as before. 

This gives rise to the chances of scarring or narrowing of the ureters when there is constant stretching in the tissues, which have now lost their elasticity to a fair degree. Tissue elasticity is a major cause for geriatric ureteric obstructions and it is one of the natural causes that can affect any aging person. 

The key is to maintain a healthy diet and follow an active lifestyle to ensure your tissues can retain their elasticity for as long as possible.

Previous Chronic Medical Conditions

Any prior history of chronic urological conditions can increase your risk for ureteric strictures. Be it prostate issues or urinary tract infections, these conditions can adversely affect your risk of getting strictures. Apart from urological conditions, other health conditions like hypertension or high blood pressure can also negatively impact your risk of getting strictures in the future. Gynecological conditions that lead to UTIs and their surgeries are also risk factors for ureteric strictures in women.

Previous Traumas

Previous trauma refers to any injury to your abdomen, back, or pelvic region that you might have experienced over the years. These injuries can damage the ureter and lead to the formation of scar tissues, which in turn cause strictures. Trauma is the most common cause for strictures in general and in the elderly, especially for people who are at fall risk, the risk factors are significantly higher.

The difficult part about trauma and strictures is that there is no guarantee that the strictures would be formed immediately after your injury. In some cases, the strictures can form years after the injury. This makes it difficult to predict which injuries can cause strictures and if they will appear or not, especially in the elderly.

Previous Interventions

Surgeries are major risk factors for ureteric strictures and as people age, the probability of them having to go through surgical interventions for other unrelated health concerns increases. However, with any surgical interventions performed on the abdomen or pelvic region of the patient, it can seriously increase the risk of ureteric strictures. 

Generally, prostate, bladder, or urethral surgeries are the ones that put the most risks of getting ureteric strictures. However, treatment for kidney stones and other renal abnormalities are also up there with the crucial risk factors for ureteric strictures, which can appear any time in the future after the procedures are performed.

Recurrent Kidney Stones

Kidney stones are passed from the kidneys through the ureter to the lower end of your urinary tract before passing it out of your body. If you suffer from recurrent kidney stones or large kidney stones, it can increase your risk of ureteric strictures significantly. Why? Because passing large stones or small stones repeatedly can injure the ureteral walls and cause the formation of scar tissues and strictures.

Kidney stones can also get lodged in the ureter causing similar symptoms as strictures. It is crucial to find the cause of your kidney stones and treat them promptly to ensure you are not putting yourself at a higher risk for strictures. Also recurrent stones can also cause recurrent strictures, which can take a serious toll on your urological health overall.

Symptoms to Detect Ureteric Stricture

Now that you know the various risk factors of ureteric strictures in the elderly, it is crucial that you also learn about the symptoms that you can use to identify the condition. These symptoms are very useful in diagnosing the condition and helping you identify the early signs of ureteric strictures. An early diagnosis can help you get more treatment options and ensure you can keep the risk of recurrence in check. So, what are the most important symptoms of ureteric strictures for the elderly? Let’s find out.

• Urinary Frequency: As you age, the number of times you need to urinate can naturally increase. However, if you are noticing that the frequency has suddenly increased significantly in a short span, it can indicate anomalies with your urological health and even strictures.
   
• Urine Urgency: Along with frequency, urgency is another important symptom that can point towards strictures. If you are noticing that you need to urinate urgently whenever there is a need, it can be signs of a condition known as urinary incontinence. And urinary incontinence can also be a sign for ureteric strictures. So, it is important that you keep a note of these symptoms and inform your doctor about them.
   
• Flank & Lower Back Pain: Ureteric stricture causes urine backflow into the kidneys, which can cause a dull constant pain in your flanks, abdomen, and lower back. Sometimes, the pain can also radiate to your pelvic region. If you are noticing you have flank pain along with the other symptoms mentioned above, it can be a clear sign of ureteric strictures. You need to get checked out immediately in such cases to ensure you can get started with the treatment options quickly.
   
• Hematuria: Hematuria is a condition that causes blood to pass through your urine. It is a chronic condition that can be an indication of kidney problems and even ureteric strictures. If you are experiencing hematuria combined with the other symptoms, it can be a sign of severe ureteric strictures. Please get medical help if you are experiencing blood in your urine a few times in a row.

Ureteric Stricture Diagnosis

Diagnosing the problem based on the symptoms is the next step of treating the condition. Doctors can use both invasive and imaging tests to diagnose ureteric strictures. For elderly, doctors generally stick with imaging and blood tests to ensure their risks are not elevated. Only in rare cases are invasive diagnostic tests used to diagnose ureteric stricture in the elderly. Here are some of the most common diagnostic tests used.

• Blood Test: Blood tests are commonly used to check for imbalances of certain compounds in the body. Based on the reports, doctors can make a diagnosis if the patient has strictures or not. Generally, a higher percentage of certain hormones or uric acid in the blood can indicate abnormalities of the ureter like strictures.
   
• Urinalysis: After blood tests, urine tests or urinalysis is a great way to diagnose strictures. In most cases, urinalysis in the elderly can diagnose if the patient has strictures or not based on the study of the urine composition. However, in certain cases, urine tests are not enough and imaging tests are required to understand the location and size of the stricture.
   
• X-Rays: X-rays are one of the most easily available and commonly used imaging tests used for diagnosing ureteric strictures. A contrast medium is inserted into the urinary tract through the urethra so that the X-ray can accurately show the location and size of the stricture clearly. With the imaging tests showing the location of the stricture, the treatment processes can start easily. However, in certain cases, other imaging tests like CT Scans might also be required.
   
• CT Scans: CT Scans are required in case the strictures are many, located in difficult regions, or are very large. This test can help doctors get a clear image, and use it to start the treatment process as soon as possible.

Ureteric Stricture Treatment Options

Surgical treatments are the most popular treatment options for ureteric strictures. With new technology, today patients don’t need to go for open surgeries anymore. There are multiple minimally invasive surgical options for ureteric strictures all of which have low risk and quick recovery compared to open surgery. Here are the best options.

Balloon Dilation

Balloon dilation is one of the easiest surgical treatments for ureteric strictures. Much like angioplasty, balloon dilation involves inserting a balloon into your ureter through the urethra and bladder, and inflating it to remove the stricture. This procedure is safe and quick. Patients can go home the same day of the procedure as it is performed on an outpatient basis. This procedure is very successful for strictures less than 1 cm in length. However, even with larger strictures, multiple dilations can clear out the strictures.

Stent Placement

Stent placement is a temporary treatment for ureteric strictures, but it is completely effective. Based on the location and size of the stricture, custom stents are made for the patients using biocompatible materials. The stent is inserted into the body through the urethra and placed inside the stricture to open the ureter. In the elderly, stents can be a permanent solution to their problem as long-term stents are also possible. Doctors may, however, need to remove the stents and place new ones every six months.

Ureterorenoscopy

Ureterorenoscopy is one of the best treatment processes for ureteric strictures because it completely nullifies the risk of recurrent strictures in the same location. In this procedure, doctors cut out or melt the stricture using surgical tools or lasers. This procedure is very precise and ensures that the nearby tissues are not damaged in any way. In some cases, if the stricture is cut out, tissues from the other parts of your body are grafted in its place. This procedure requires serious expertise, so you should only get it from the best institutions that house the most experienced doctors and infrastructure.

Conclusion

Ureteric strictures in the elderly can cause other conditions and problems in the kidney, which can have dire consequences for their overall health. If and when you start noticing the symptoms mentioned here, you should visit your doctor and tell them about it. An early diagnosis can help you get rid of your strictures easily without the risk of recurrence. All you need is a trustable healthcare institution that has the experience and expertise needed to treat your condition swiftly and safely, like MASSH. 

We specialise in the treatment of all types of urological conditions and our experienced team and world-class infrastructure ensures you are safe from the risk of recurrence with a quick and easy recovery. Visit our website to learn more about the conditions we treat.