Ureteric stricture (ureteral stricture) is the
pathological narrowing of the
ureter which may lead to serious complications such as
kidney failure.
Pathophysiology
Several conditions have been identified to cause
iatrogenic
injuries, tumours and radiotherapy.
Iatrogenic injuries
urological procedures are common with the advancement of medical
technology which allows endoscopic procedures to be among the main operative modalities in
urology. However,
complications can occur, and iatrogenic injury is disruption of healthy tissue which might lead to local
inflammation in the process of healing and scarring which can result in ureteric stricture.
Non-endoscopic open surgical procedures such as colon surgery where the operation field is very close to the adjacent retro
gynaecological operations near the ureters can lead to their injury, one of the common conditions where surgical plans are not clear is the presence of advanced
endometriosis.
Radiotherapy
Radiotherapy had been identified as a cause of ureteric strictures formation. Damage occur as a result of both direct and indirect insults such as direct injury to
cell proteins and
DNA or
mutation of the DNA which leads to future insults respectively.
[1] This is not surprising as in the same way radiotherapy is expected to treat cancer and hence collateral damage can occur hence it can be challenging to treat as blood supply and vascularity are believed to be affected when stricture repair is intended.
[2] For instance, Radiotherapy of
cervical cancer can cause ureteric stricture in 2.2% of patients at 10 years.
[3]Radiotherapy had been identified as a modality of treatment of several cancers in the pelvis and the abdomen which may lead to ureteric stricture formation among other urological adverse effects too such as radiation induced
.
Impacted ureteric stones
ipsilateral
kidney and build up of pressure manifested as hydronephrosis. Several studies were conducted to find stricture rates which varies from one to another but it seems that modern technology and treatment approaches are minimising the chances for stricture development post impacted stone treatment.
Symptoms
The
, hence loin pain resulting from hydronephrosis and building up of pressure in the renal pelvis from obstructed urine flow which leads to its statics and pain.
Other symptoms related to ureteric strictures can be those related to complications such as recurrent UTI.
Diagnosis
Ureteric strictures can be diagnosed using both imaging modalities and under direct vision through endoscopic procedures such as Ureteroscopy.
Several
Tumours
or impacted stones.
MAG3 studies. Dynamic imaging are well known to play an essential diagnostic rule too such as
Whitaker test. Overall, national and local guidelines, surgeon preferences and availability of the diagnostic modality plays a rule in choosing the diagnostic modalities used.
Treatment
Treatment of ureteric strictures varies from one patient to another depending on the level, cause and extent of stricture in addition to patient factors such as comorbidities and preferences. Treatment options include
to reconstruct ureters are used and had various success rates.
Technology is driving more hope finding more treatment options, laparoscopic assisted robotic techniques are developing and been reported while tissue engineering for reconstruction is not developed yet as it is in other urological reconstruction topics.[5]
References
