Strictures of the ureters and urethra are treated by Urologists.
Ureteral Stricture Disease
Causes of Ureteral Strictures:
– Malignancy (TCC, cervical, prostate, ovarian, colon CA).
– Periureteral fibrosis (AAA, endometriosis)
– Iatragenic (manipulation) – 1% incidence of post-ureteroscopy strictures with modern instruments
Urolithiasis – impacted ureteral stones for more than 2 months are associated with 24% incidence of strictures
Evaluation of Ureteral Strictures:
Biopsy of ureteral strictures are always indicated if the etiology of the stricture is not certain.
It is crucial to define the exact location and length of the stricture before intervening to address it surgically. We perform a thorough evaluation of the stricture location prior to advising on a management plan.
Options for Management of Ureteral Strictures:
– Balloon dilatation
– Combined antegrade/retrograde approach with re-cannulization of obliterated lumen
– Laparoscopic, Robotic or Open surgical repair
- Psoas hitch
- Boari flap
- TUU (Transureteroureterostomy)
- Ileal ureteral substitution
If you need care for ureteral or urethral stricture disease, contact Dr. Shteynshlyuger, an expert in management of complex urologic conditions.
Trauma (straddle trauma) is the most common cause of urethral strictures in the US.; BXO and iatragenic trauma are less common. Inflammatory strictures due to gonorrhea are less common. The role of Chlamydia/urethroplasma are unclear.
Patients usually present late with voiding symptoms, urinary infections such as prostatitis or Epididymitis; urinary retention.
Length, location, depth and the presence of spongiofibrosis need to be determined:
– U/S, retrograde studies
– Endoscopic evaluation
Treatment Options for Urethral Strictures:
– Self catheterization can delay stricture recurrence
Cold knife urethrotomy
Urolume: a urethral stent to keep the urethral stricture open
Open reconstruction: surgical treatment to excise and repair urethral stricture, also called urethroplasty.