Ureteric Stricture Surgery in Jaipur

• Stone disease and stone surgery: a stone stuck in one place for weeks can scar the ureter wall, and ureteroscopy can occasionally injure it
• Pelvic and abdominal surgery: the ureter runs close to the uterus, colon and large blood vessels, so it can be injured during hysterectomy, caesarean section or bowel surgery
• Radiotherapy: for cancer of the cervix, prostate, bladder or rectum, sometimes causing a narrowing years later
• Tuberculosis: TB of the urinary tract can scar the ureter in several places and shrink the bladder; anti-TB medicines come first, and repair is planned once the infection is controlled; see urinary tuberculosis
• Other causes: injury from an accident, scarring around the ureters (retroperitoneal fibrosis), and cancer of the ureter or nearby organs

Because cancer can look like a simple stricture, it is ruled out before repair, especially when there is no clear cause.

Symptoms include a dull ache or sharp pain in the side, repeated urine infections or fever, and sometimes blood in the urine. Many strictures cause no symptoms and are found when a scan shows a swollen kidney, for example at a check-up after stone surgery.

Repair is usually advised when the kidney still has useful function and the narrowing causes blockage, pain or infection. It is usually not advised when the kidney has almost no function left; removing the kidney may then be simpler. In people who are too unwell for a major operation, a stent changed at regular intervals can be a long-term option.

• Ultrasound, to see swelling of the kidney
• CT urography, a CT scan with dye that shows the ureter, the level of narrowing and the surrounding tissues
• Diuretic renogram (DTPA or EC scan), to measure how much the kidney contributes and how well it drains
• Retrograde study: dye injected from below through a cystoscope. When a nephrostomy is in place, dye is also injected from above. Together these show both ends of the narrowing and its exact length.
• Ureteroscopy and biopsy if cancer is suspected, and urine tests for TB when indicated
• Bladder assessment, because bladder-based repairs need a bladder of reasonable size

If the kidney is blocked, infected or losing function, urine is drained before any repair:

• DJ stent: a soft tube placed through the narrowing from the bladder, using a cystoscope
• Percutaneous nephrostomy: a thin tube placed through the back directly into the kidney under ultrasound or X-ray guidance, draining into a bag, used when a stent cannot pass

This relieves pain, controls infection and lets the kidney recover. After an injury during surgery, a repair is sometimes done within days; otherwise it is often planned after a few weeks to months, once swelling and inflammation settle. Practice varies, and the timing is decided after the tests.

The right operation depends mainly on the level of the stricture and its length.

Ureteroureterostomy

The narrow segment is cut out, the two healthy ends are opened lengthwise and stitched together without tension, over a stent.

Reimplantation with psoas hitch

The diseased lower ureter is removed and the healthy ureter is joined to the bladder. The bladder is lifted and stitched to the psoas muscle in the pelvis so it reaches the ureter.

Boari flap

A strip of bladder wall is cut, rolled into a tube and turned upwards to meet the ureter, replacing a longer missing segment.

Ureterocalicostomy

Some thin kidney tissue at the lower pole is removed and the ureter is joined directly to the lowest cup-shaped drainage space of the kidney (calyx).

Other options

A short, recent narrowing can sometimes be treated from inside with a balloon or a laser cut through a ureteroscope; this is less lasting and suits only selected cases. Very long strictures may need a segment of bowel to replace the ureter or other complex repairs, planned with the right specialists.

1. General anaesthesia; a cystoscope is often used first to place a guide wire or stent.
2. The ureter is reached by laparoscopic (keyhole) surgery or an open cut, chosen according to the level, the length and any scarring from earlier surgery or radiotherapy.
3. Scar tissue is removed back to healthy, well-supplied ureter.
4. The repair is stitched with fine absorbable stitches over a DJ stent; a drain and bladder catheter are left.

Surgery usually takes 2-4 hours. Equipment includes the laparoscopic camera and instruments or open surgical instruments, a cystoscope, guide wires, DJ stents and catheters. The operation is done at ManglamPlus Medicity, Mansarovar. Read about keyhole surgery in general on the laparoscopic urology surgery page.

Call the clinic for fever, increasing pain in the side or abdomen, urine leaking from the wound, a catheter that stops draining, or a nephrostomy tube that falls out.

• Urine leak from the join, usually settling with the stent, catheter and drain
• Narrowing again, which may need a stent, an endoscopic procedure or a further operation
• Infection, bleeding, and injury to bowel or blood vessels: uncommon
• After a Boari flap or psoas hitch, passing urine more often for some weeks; urine may flow back up the new join, which is usually harmless in adults

Repairs made from healthy tissue usually drain well over the long term. Strictures after radiotherapy or TB are more difficult, as the tissue heals less well. Because narrowing can return months later without pain, follow-up scans are important even when you feel well.