Definition
A ureteric stricture is a pathological narrowing of the ureter, the muscular tube that conveys urine from the renal pelvis to the urinary bladder. The constriction impedes normal urine flow and can lead to upstream dilatation (hydroureter) and renal impairment.
Overview
Ureteric strictures may be congenital or acquired. Acquired strictures are more common and arise from a variety of etiologies, including iatrogenic injury (e.g., surgical ligation, endoscopic procedures), trauma, inflammatory conditions (e.g., ureteritis, retroperitoneal fibrosis), obstructive stones, radiation therapy, and malignant infiltration. Clinical presentation often includes flank or abdominal pain, recurrent urinary tract infections, hematuria, and signs of obstructive uropathy such as hydronephrosis. Diagnosis relies on imaging modalities—ultrasound, computed tomography (CT) urography, magnetic resonance urography, and retrograde pyelography—as well as functional studies when indicated. Management is individualized and may involve endoscopic dilation, placement of ureteral stents, balloon catheter dilation, or reconstructive surgery (e.g., ureteroureterostomy, ureteroneocystostomy, or ileal ureter substitution) depending on stricture length, location, and underlying cause.
Etymology/Origin
- Ureteric: derived from “ureter,” which originates from the Greek word οὔρη (oure) meaning “urine” and the suffix -τηρ (-ter), denoting an instrument or carrier; thus “ureter” literally means “urine carrier.”
- Stricture: from Latin strictus, the past participle of stringere meaning “to draw tight, to bind.”
Characteristics
- Location: Can occur at any segment of the ureter (proximal, middle, or distal). Distal strictures are most frequently encountered in iatrogenic contexts.
- Length: Short (<2 cm) strictures are often amenable to endoscopic treatment; longer strictures may require open or robotic reconstruction.
- Etiology:
- Iatrogenic (post‑surgical, endoscopic, or lithotripsy‑related) – 30–50 % of cases.
- Inflammatory/fibrotic (e.g., retroperitoneal fibrosis, chronic infection) – 15–25 %.
- Traumatic – 5–10 %.
- Malignant (direct tumor invasion or external compression) – variable, depending on cancer type.
- Symptoms: Flank pain, renal colic, recurrent pyelonephritis, reduced renal function, possible palpable mass in severe hydronephrosis.
- Diagnostic findings: Dilated renal pelvis and ureter proximal to the stricture on imaging; delayed excretion of contrast; “kinking” or abrupt caliber change on retrograde studies.
- Treatment modalities:
- Endoscopic: Cold‑knife incision, laser incision, balloon dilation, temporary stenting.
- Minimally invasive surgery: Laparoscopic or robotic ureteral reimplantation, ureteroureterostomy.
- Open reconstruction: Boari flap, psoas hitch, ileal ureter substitution for extensive disease.
Related Topics
- Ureter
- Hydronephrosis
- Ureteric injury
- Urolithiasis (kidney stones)
- Retroperitoneal fibrosis
- Ureteral stent
- Pyeloplasty (surgical reconstruction of the renal pelvis)
- Renal colic
- Urothelial carcinoma
This entry summarizes currently established medical knowledge about ureteric strictures as presented in peer‑reviewed urology texts and clinical guidelines.