Ureteral stricture

Ureteral stricture is a pathology that leads to compression of the lumen of the ureteral canal, as a result of which its patency is impaired.

The content of the article:
Causes of ureteral stricture
Symptoms of ureteral stricture
Diagnosis of ureteral stricture
Treatment of ureteral stricture
Consequences and complications of ureteral stricture
Ureteral stricture
Under normal conditions, the walls of the ureter are elastic, which does not prevent their natural expansion. When certain disorders form in them, the muscles atrophy and degenerate into scar tissue. Narrowing can form in different parts of the ureter and have different lengths.

As a result of the development of the disease, the ureter is partially emptied, which will cause the accumulation of urine residues. From prolonged stagnation, there is stretching, tortuosity of the urea, elongation, which will provoke an increase in the pelvis of the kidneys (hydronephrosis) and lead to unsatisfactory kidney function. Stricture often occurs at the site of the transition of the pelvis to the ureter and at the transition of the ureter to the bladder area.

The following types of ureter stricture are distinguished:

one – sided;
bilateral;
singles;
multiple;
false ones are constrictions that have arisen due to external compression, compression of the walls of the ureter by various tumors;
true — affecting the duct wall.
The ureter is a paired organ. In this regard, the disease can develop only on one organ, and the second will be healthy. Bilateral stricture is extremely rare and can be easily identified. Unilateral stricture proceeds without any special signs.

Depending on the type of disease, the source of the development of constrictions, their location and base are determined. According to the location of the narrowing, there are: stricture in the upper, lower and middle sections, it can have different lengths and appear in different places of the urinary duct.

Causes of ureteral stricture
There are a number of circumstances that provoke pathological narrowing of the ureter. Often, this condition is formed during life and is caused by many factors (compression of the ureter, kidney tumor, medical intervention, viral and venereal diseases). There are also congenital strictures of the ureter. They are caused by various abnormalities of intrauterine development of the fetus, may be of a genetic nature. In this case, the disease is formed as a result of underdevelopment of the muscular tissues of the ureter, inflection and abnormal development of the kidneys. Thus, a scar of dense connective tissue forms at the site of the injury, so the lumen of the urethra narrows. With urethral stricture, the patient has only a decrease in the urine stream, and the narrowing of the ureter may not give itself away for a long time.

Causes of ureter stricture:
Ureteral injuries: this may be a knife or gunshot wound, an injury caused by medical actions;
external injuries — appear from blunt blows in the lumbar region. The narrowing in this case occurs due to a hematoma.
internal injuries — the process of inflammation occurs from the formed kidney stones. In case of violation of the mucous membrane by a stone, the formation of connective tissue occurs.
Radiation therapy, radiation damage;
Abnormalities and inflammation of the ureter;
Prolonged stay of the stone in the ureter;
Viral diseases caused by the colonization of the walls of the ureter by parasites;
Tuberculosis, gonorrhea.
In most cases, men are most susceptible to this disease.

Symptoms of ureteral stricture
Narrowing of the urethral canal is accompanied by the following symptoms:

pain and discomfort when urinating;
the presence of blood in the urine;
cloudy color and unpleasant smell of urine;
weakened jet;
spray jet;
the presence of general intoxication of the body (nausea, vomiting);
muscle cramps;
decrease in volume or no urine at all;
pain in the lower back area;
increased body temperature;
discharge from the ureter;
a feeling of pulling pain in the lower abdomen.
Diagnosis of ureteral stricture
You can diagnose this disease in the following ways:

Study of the patient’s clinical record;
Determining the time of occurrence of the first complaints;
Blood and urine analysis to determine the presence and level of inflammation in the body;
Ultrasound examination of the kidneys and bladder to identify the size and level of narrowing of the ureter;
The introduction of an intravenously safe radioactive drug, which is excreted by the kidneys, after which several photographs are taken. This method can determine the size and extent of the narrowing;
Insertion of the tube with the device through the urethra into the ureter to determine the location of the constriction;
Tomography will determine the cause of ureter stricture;
Visual examination of the ureter with a cystoscope makes it possible to determine the presence of the disease;
After determining the location and size of the stricture, the doctor will be able to prescribe a comprehensive treatment.
Treatment of ureteral stricture
The main goal of treatment is to eliminate the narrowing of the flow stream and resume the outflow of urine.

There is no medical treatment for this disease. The only possible way out is surgery.

Options for operations on ureteral stricture:

Urethral augmentation is the expansion of the lumen of the canal with a special rod. This method has a temporary result, so it is rarely used. Pain, bleeding and infection may occur during the procedure.
Optical urethrotomy — dissection of the narrowing area using a cystoscope. In comparison with bougie, this method is much more effective, but for strictures with a length of no more than 0.5 cm.
Urethral plastic surgery is the replacement of the affected area of narrowing with healthy tissues. This method is used for small-sized strictures.
Plastic replacement surgery is used for extended strictures.
To avoid undesirable consequences, it is important to follow the rules of rehabilitation prescribed by the doctor.

Consequences and complications of ureteral stricture
Ureteral stricture can provoke such consequences and complications as chronic prostatitis, cystitis, kidney atrophy, as well as frequent exacerbations of pyelonephritis (inflammation of the renal tissues), the appearance of kidney stones and chronic insufficiency, metabolic products can accumulate in the body.

It is necessary to adhere to certain rules of prevention in order to avoid the consequences and exacerbations of ureter stricture:

avoiding back and lower back injuries;
timely treatment of urolithiasis;
early diagnosis of ureteral diseases;
regular ultrasound examination of all organs of the urethra after surgery;
the use of contraceptives.

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