techroki.com – A ureteral stricture is a narrowing of one or both ureteral tubes. The ureters are tubes that carry urine from the kidneys to the bladder. In this condition, part of the narrowed ureter will cause obstruction, which is blocking the passage of urine into the bladder.
Generally, this condition rarely causes complications. But if not treated immediately, the blocked urine can flow back into the kidneys and then infect and damage these organs. In severe cases, the disease can also lead to kidney failure, sepsis (life-threatening infection) or death.
How common are ureteral strictures?
Ureteral stricture is a fairly common case. This condition often occurs in men over 60 years who have BPH (benign prostate enlargement).
When the prostate enlarges, urine flow becomes blocked and accumulates in the bladder. This can later push the ureter and cause blockage.
If you have any questions and need further information regarding ureteral strictures, please discuss them with your doctor.
What are the symptoms of a ureteral stricture?
In some patients, ureteral strictures are asymptomatic, others have mild symptoms. However, symptoms can also appear gradually if the blockage occurs slowly.
Signs and symptoms are felt depending on where the stricture is located, and whether the patient has other diseases of the urinary system. Patients with kidney problems may experience more severe symptoms.
Some of the symptoms of a ureteral stricture are:
- severe pain around the abdomen, lower back, or the side under the ribs,
- nausea and vomiting,
- difficulty urinating (anyang-anyangan),
- urinating more frequently,
- swollen feet, and
- cloudy or bloody urine (hematuria).
- When should you go to the doctor?
You should immediately consult a doctor if you start to feel the symptoms. Especially if the symptoms that appear start to make it difficult for you to urinate. It is better to consult a doctor as soon as possible to get the right treatment early.
What causes this condition to arise?
The causes of ureteral strictures vary, some cases can be congenital from birth. Strictures can occur due to abnormalities in the structure of the organ. These disorders include:
1. Duplex kidney
A person is said to have a duplex kidney if one kidney has two ureters at the same time. Please note, normally each kidney only has one ureter. This condition has been present since birth.
When one of the ureters is not functioning properly, it can allow urine to flow back into the kidney and cause damage.
2. Ureteropelvic junction
Ureteropelvic junction is a condition in which the ureters connect to the bladder or kidneys, thereby blocking the flow of urine.
This disorder can be congenital or can appear later in life as a result of injury or scar tissue (new skin tissue that forms after an injury), or it can arise from tumor development.
When the ureter narrows, it can cause a small bulge at the end of the ureter close to the bladder. A ureterocele can block the flow of urine and allow urine to flow back into the kidney.
4. Retroperitoneal fibrosis
This disorder occurs when fibrous tissue grows in the area behind the abdomen. Fibrous tissue is the connective tissue that supports one organ from another. Fibrous fibers will grow and then surround and narrow the ureter, making it difficult for urine to flow.
In addition, ureteral stricture can also be caused by certain diseases such as:
- urinary stones,
- kidney stones,
- cancer of the urological system,
- tissue growths such as endometriosis,
- severe constipation,
- long-term swelling of the ureteral wall,
- effects of pelvic radiation therapy and treatment of other urological diseases,
- urine diversion surgery, and
- external injury.
How to diagnose ureteral stricture?
Sometimes a ureteral stricture may present as an abnormality. If this is the case, the doctor can diagnose the abnormality before the baby is born with an ultrasound.
If the condition only appears after a while, then the examination will be carried out after you feel the symptoms. The doctor will of course do a physical examination first.
During this examination, your doctor may ask you about your medical history and any medical procedures you have had. This information will help your doctor identify possible problems with your urinary system.
After that, you still have to do a follow-up examination if a ureteral stricture is suspected. The various procedures are:
- Blood tests and urine tests. The doctor will examine blood and urine samples for signs of infection or creatinine, which could be related to kidney problems.
- Ultrasound (USG). Using high-frequency sound waves, this procedure will produce images of your internal organs to show the condition of your kidneys and ureters.
- Voiding cystourethrogram. The procedure involves inserting a catheter through the ureter, injecting a dye into the bladder to take X-rays of the kidneys, ureters, bladder, and urethra before and during urination. The procedure aims to test the flow of urine.
- Ureteroscopy. A small tube with an optical system will be inserted through the urethra into the bladder and ureters to determine the condition.
- CT scan. A scanning procedure to detect abnormalities using X-rays as well as computer processing.
- Magnetic resonance imaging (MRI). An MRI uses a magnetic field and radio waves to produce a clearer picture of the organs and tissues around the urinary system.
What are the treatment options for ureteral stricture conditions?
Treatment will be done aims to overcome the blockage. Sometimes treatment also includes giving antibiotics to prevent infection problems. In general, this condition can be treated with two procedures, namely drainage procedures and surgical procedures.
A drainage procedure will be performed if the ureteral stricture has caused severe pain. This procedure is done to expel urine and relieve the problem of blockages. There are two drainage procedures that patients can undergo, including:
- Ureteral stent. The doctor will insert a tube into the ureter to drain urine from the kidney to the bladder. This hose will be attached to the affected part of the stricture.
- Percutaneous nephrostomy. The doctor inserts a tube through the back using a needle to drain urine directly.
- catheter. A catheter tube will be inserted through the ether to connect the bladder to the external drainage bag. This procedure may be an option for patients with poor kidney filtering function.
For the most part, the results of the drainage procedure are only temporary. However, the results can also have a permanent impact, depending on your condition.
For a more permanent result, a surgical procedure can be an option. There are a number of surgical procedures that can be performed to repair a stricture in the ureter. The type chosen depends on the conditions. Some of the types of operations are:
- Endoscopic surgery. Endoscopic surgery is a minimally invasive procedure. The doctor will make an incision in the damaged part of the ureter to widen the area and place a tube called a stent in the ureter to keep it open.
- Open operation. The doctor will make an incision in your abdomen to perform the operation.
- Laparoscopic surgery. The procedure involves making a small incision in the abdominal area and inserting a small camera and light tube into the ureter to perform the operation.
- Laparoscopic robot-assisted. Robotic system assistance will be provided to perform the surgery.
After surgery, you will still have to do a number of treatments in the hospital. Later, you will be given medicine to deal with the pain from the surgery. A urinary catheter will be in place for several days to help drain urine during recovery.
The new catheter will be removed before you go home. Sometimes, there are also patients who still need to be assisted with a catheter. Doctors and medical workers will tell search to treat him at home.
What treatments should be done at home to improve the condition after ureteral stricture surgery?
After returning to the hospital, you must carry out a number of treatments and adhere to the taboos that the doctor has given you. In this recovery, ask other family members or friends for help.
Some of the instructions that patients generally have to follow after surgery are as follows.
- Take medicine according to the rules and doctor’s prescription.
- Avoid activities that involve heavy lifting and high-intensity activities.
- Do not drive until you have finished taking pain medication.
- Avoid straining too hard during bowel movements, if necessary you can ask for laxatives according to the doctor’s advice.
- Avoid swimming or bathing in hot water. You must get approval from your doctor before doing this.
If there are complaints or symptoms that reappear, immediately consult your doctor to get the right treatment.