Summary about Disease
A ureteral stricture is a narrowing of the ureter, the tube that carries urine from the kidney to the bladder. This narrowing can obstruct the flow of urine, potentially leading to kidney damage, infection, and pain. The stricture can be caused by various factors, including injury, surgery, infection, or congenital abnormalities. Treatment aims to relieve the obstruction and restore normal urine flow.
Symptoms
Symptoms can vary depending on the severity and location of the stricture. Common symptoms include:
Flank pain (pain in the side or back)
Abdominal pain
Frequent urinary tract infections (UTIs)
Decreased urine output
Difficulty urinating
Blood in the urine (hematuria)
Feeling of incomplete bladder emptying
Kidney stones
High blood pressure
In severe cases, kidney failure.
Causes
Ureteral strictures can be caused by:
Surgery: Previous abdominal or pelvic surgery, including ureteroscopy, can damage the ureter.
Injury: Trauma to the abdomen or pelvis.
Infection: Chronic or severe urinary tract infections or other infections near the ureter, like tuberculosis.
Inflammation: Conditions like retroperitoneal fibrosis.
Kidney stones: Large or impacted stones can cause inflammation and scarring.
Tumors: Growths either within or pressing on the ureter.
Congenital: Some individuals are born with narrow ureters.
Idiopathic: In some cases, the cause is unknown.
Medicine Used
Medicines used to manage ureteral strictures mainly address symptoms and related complications. They do not directly treat the stricture itself, which usually requires a procedure.
Antibiotics: To treat urinary tract infections.
Pain relievers: Analgesics (e.g., NSAIDs, opioids) to manage flank or abdominal pain.
Alpha-blockers: Sometimes used to relax the smooth muscle in the ureter and bladder neck, potentially easing urine flow (though not directly addressing the stricture).
Blood pressure medication: If the stricture has led to high blood pressure, medication to lower it may be prescribed. The primary treatment for a ureteral stricture usually involves a procedure to open or bypass the blockage.
Is Communicable
No, a ureteral stricture is not a communicable disease. It cannot be spread from person to person.
Precautions
Precautions to minimize the risk of developing a ureteral stricture can include:
Prompt treatment of UTIs: Complete antibiotic courses and follow up with your doctor if symptoms persist.
Careful surgical technique: If undergoing abdominal or pelvic surgery, choose an experienced surgeon.
Manage kidney stones: If you have kidney stones, work with your doctor to manage them to prevent them from causing blockages or inflammation.
Avoid Trauma: Take precautions to avoid injury to the abdomen and pelvis.
How long does an outbreak last?
Ureteral strictures are not infectious and do not involve "outbreaks." The symptoms of a ureteral stricture can be chronic and persistent until the stricture is treated. The duration of symptoms depends on the severity of the blockage and how long it takes to diagnose and treat the condition.
How is it diagnosed?
Diagnosis typically involves:
Medical History and Physical Exam: The doctor will ask about your symptoms and medical history.
Urinalysis: To check for infection or blood in the urine.
Blood Tests: To assess kidney function.
Imaging Studies:
Ultrasound: Can show hydronephrosis (swelling of the kidney due to urine backup).
CT Scan: Provides detailed images of the urinary tract to identify the location and extent of the stricture.
MRI: May be used if CT is not suitable.
Intravenous Pyelogram (IVP): X-ray of the urinary tract after injecting contrast dye.
Retrograde Pyelogram: Contrast dye is injected directly into the ureter to visualize it.
Cystoscopy and Ureteroscopy: A thin, flexible tube with a camera is inserted into the bladder and ureter to visualize the stricture directly and obtain biopsies if necessary.
Timeline of Symptoms
The timeline of symptoms can vary greatly.
Early Stages: May be asymptomatic or have mild, intermittent flank pain. UTIs may be the first noticeable symptom.
Progression: As the stricture worsens, pain may become more frequent and intense. Urine output may decrease.
Advanced Stages: Frequent UTIs, kidney stones, high blood pressure, and potentially kidney damage can occur. Untreated, this can lead to kidney failure.
Important Considerations
Early diagnosis and treatment are crucial to prevent kidney damage.
The choice of treatment depends on the location, length, and cause of the stricture.
Treatment options include endoscopic procedures (ureteroscopy with balloon dilation or stent placement) or open/laparoscopic/robotic surgery (ureteral reconstruction or reimplantation).
Long-term follow-up is necessary to monitor for recurrence.
Kidney function should be closely monitored throughout treatment.
Discuss all treatment options and their potential risks and benefits with your doctor.