About Ureteric Stricture

A ureteric stricture refers to the abnormal narrowing of the ureter—the tube responsible for transporting urine from the kidneys to the bladder—resulting in restricted or blocked urine passage. This condition is more often seen in men due to their longer urethral anatomy, while it’s infrequent in women and children. Ureteric strictures can develop at any age and at any part along the urinary tract, potentially causing major urinary difficulties. The constriction may originate at the upper end near the kidney or lower end near the bladder. Several factors can lead to this condition:

Signs and Symptoms of Ureteric Stricture

• Reddish or dark-colored urine
• Seminal bleeding
• Weak or halted urine stream
• Spraying during urination
• Burning or pain while passing urine
• Lower abdominal discomfort
• Dribbling of urine
• Repeated urinary infections in men
• Swelling of the penis
• Involuntary urine leakage

What Causes a Ureteric Stricture?

• Injury or Physical Trauma to the Urinary Tract:
  Mechanism: Direct trauma to the ureter or adjacent structures can trigger inflammation and fibrous tissue formation, narrowing the passage. Though injuries to the urethra are common, trauma impacting the ureter itself poses a more direct risk.
  Examples: Blunt force (e.g., vehicle accidents), sharp injuries (e.g., stab wounds), or ureteral tears from moving kidney stones.
  Healing Process: As the body repairs itself, excessive scar tissue may form and gradually shrink the ureter’s opening, often taking weeks to manifest.
• Infections (Including STDs):
  Mechanism: Persistent infections can cause chronic inflammation within the ureter, eventually scarring it. While STDs often affect the urethra, if not treated in time, they may extend toward the upper tract.
  Infectious Agents: Gonorrhea and chlamydia are notable culprits. In rare cases, tuberculosis may lead to urinary tract strictures.
  Progression: Ongoing infection erodes the inner ureter lining, stimulating fibrosis and narrowing. This risk increases with recurrent untreated urethritis.

Surgical Injury:
 Mechanism: Operations involving pelvic or urinary structures can unintentionally damage the ureter, leading to stricture formation.
 Common Causes:

• Urological Procedures: Surgeries like ureteroscopy or lithotripsy may inadvertently scrape or puncture the ureter.
• Pelvic Surgeries: Hysterectomies, bowel surgeries, or vascular interventions might damage the ureter through clamping, heat, or cutting.
• Radiation Exposure: Pelvic cancer treatments can gradually degrade ureteral tissue.
   Outcome: Postoperative scarring from these traumas may cause ureteral narrowing, impairing urine flow.

Additional Causes

• Stones in the Kidney or Ureter: Prolonged presence or passing of stones may damage the ureter lining.
• Birth Defects: Some individuals are born with narrower ureters that deteriorate with time.
• Tumors: Internal or external growths near the ureter can press on it, mimicking stricture symptoms.

Ureteric Stricture Risk Factors

• Past injury or trauma to abdomen/pelvis
• Frequent urinary or sexually transmitted infections
• Previous surgeries in the pelvic or abdominal region
• Higher prevalence in adults with stone or surgical history

Ureteric Stricture Potential Complications

• Hydronephrosis: Urine backs up into the kidney, causing swelling and pressure.
• Infections: Stagnant urine encourages bacterial growth, possibly leading to kidney infections or sepsis.
• Kidney Function Loss: Continuous blockage can shrink kidney tissue and lead to organ failure.
• Pain and Discomfort: Typically in the flanks or lower abdomen due to pressure build-up.
• Stone Formation: Obstructed flow may lead to mineral crystal build-up.

Ureteric Stricture Diagnosis

Clinical Examination
Doctors assess the genitals and urethra for signs of abnormality or swelling. In men, they may feel along the urethra or check the prostate. Observing urine flow patterns can offer clues to a potential blockage.

Imaging Tests

• X-ray with Contrast (Retrograde Urethrogram): Dye is injected to map the urethra’s shape and reveal any narrowing.
• Ultrasound: Offers detailed visuals of the urinary tract, indicating the location and extent of narrowing.

Endoscopic Evaluation (Urethroscopy)
A slender scope is introduced into the urethra to inspect the internal lining. This helps assess the tightness and length of the stricture. It may be combined with immediate minor procedures like dilation.

Retrograde Urethrogram
This diagnostic test is particularly valuable in men. Contrast dye is used to backflow into the urethra, clearly marking where and how severe the stricture is on X-ray imaging.

Other Diagnostic Approaches

• Uroflowmetry: Analyzes how fast and how much urine is passed.
• Post-Void Residual (PVR): An ultrasound measures leftover urine post-voiding, revealing incomplete emptying.
• Urinalysis & Cultures: Help identify infections that may be linked to or caused by the stricture.
• Voiding Cystourethrogram (VCUG): Highlights urine flow and any obstructions during urination.
• MRI/CT Scans: Used in advanced or complex cases involving trauma or cancer to guide treatment planning.

Ureteric Stricture Treatment Options at MASSH MANAS

Ureteric strictures typically require interventional management rather than medications. At MASSH MANAS, we offer advanced treatment options based on individual stricture characteristics:

• Holmium Laser Endoureterotomy: A precision laser technique to cut and widen the stricture through a minimally invasive scope, enabling proper urine drainage from kidney to bladder.
• Ureteric Reimplantation Surgery: In this procedure, the narrowed ureter is reconnected or reinserted into the bladder at a new site, restoring normal urinary function and preventing reflux or obstruction.