Ureter stricture: symptoms, causes and treatment & bull; hello healthy

Definition

What is ureteric stricture?

Ureter stricture is a narrowing of one or both ureteral tubes. The ureters are the tubes that carry urine from the kidneys to the bladder. In this condition, a part of the ureter that is narrowed will cause obstruction, which is the obstruction of the passage of urine to the bladder.

Generally, this condition rarely causes complications. However, if not treated immediately, clogged urine can flow back into the kidneys and infect and damage the organ. In severe cases, this disease can also lead to kidney failure, sepsis (life-threatening infection) or death.

How common are ureteric strictures?

Ureter stricture is a fairly common case. This condition often occurs in men over 60 years of age who have BPH (benign prostate enlargement).

When the prostate enlarges, urine flow becomes obstructed and builds up in the bladder. This in turn can push the ureter and cause blockage.

If you have any questions and need further information regarding ureteral strictures, please discuss them with your doctor.

Symptoms

What are the symptoms of ureteric stricture?

In some patients, ureteric strictures are asymptomatic, others have mild symptoms. But the symptoms can also appear gradually if the blockage tends to slow down.

The signs and symptoms you feel depend on where the stricture is, 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 ureteric strictures are:

• severe pain around the abdomen, lower back, or the side under the ribs,
• fever,
• nausea and vomiting,
• difficulty when making small water (anyang-anyangan),
• urinating more frequently,
• swollen feet, and
• the color of the urine is more cloudy or bloody (hematuria).

When to see a doctor

You should immediately see a doctor if you start feeling symptoms. Especially if your symptoms start to make it difficult for you to urinate. Better to consult a doctor as soon as possible to get the right treatment earlier.

Cause

What causes this condition to appear?

The causes of ureteric stricture are different, some cases can be congenital. Strictures can occur due to abnormalities in the structure of the organs. These disorders include:

1. Duplex kidneys

A person can be said to have a duplex kidney if one kidney has two ureteral channels at once. Please note, normally each kidney only has one ureter. This condition is present from birth.

If one of the ureters is not functioning properly, it can cause urine to flow back into the kidneys and cause damage.

2. Ureteropelvic junction

Ureteropelvic junction is a condition in which a ureter connects to the bladder or kidneys, thus blocking the flow of urine.

These disorders can be congenital or they can appear at a later date as a result of injury or scar tissue (new skin tissue that forms after injury), or it can arise from tumor development.

3. Ureterocele

When the ureter is narrowed, it can cause a small bulge at the end of the ureter that is close to the bladder. Ureterocele can block urine flow and make urine flow back into the kidneys.

4. Retroperitoneal fibrosis

This disorder occurs when fibrous tissue grows in the area behind the stomach. Fibrous tissue is the connective tissue that supports one organ to another. Fibrous fibers will grow and then surround and narrow the ureter, making it difficult for urine to flow.

In addition, ureteral strictures can also be caused by certain diseases such as:

• urinary tract stones,
• kidney stones,
• cancer that attacks the urological system,
• tissue growths such as endometriosis,
• severe constipation,
• long-term swelling of the ureter wall,
• the effects of pelvic radiation therapy and other urological disease treatments,
• urine diversion surgery, and
• external injury.

Diagnosis

How is ureteric stricture diagnosed?

Sometimes ureteral strictures can 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 has only appeared after a while, then an examination will be carried out after you feel the symptoms. The doctor will certainly do a physical examination first.

During this examination, your doctor may ask you about your medical history and medical procedures. This information will help your doctor identify possible problems with your urinary system.

After that, you still need to do further tests if ureteral stricture is suspected. The various procedures are:

• • Blood test and urine test. The doctor will check 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 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 urine flow.
  • Ureteroscopy. A small tube with an optic system will be inserted through the urethra into the bladder and ureter 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.

Treatment

What are the treatment options for ureteric stricture?

The treatment that will be carried out 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 the drainage procedure and the surgical procedure.

Drainage procedure

A drainage procedure will be performed if ureteral strictures have caused severe pain. This procedure is done to pass urine and relieve congestion problems. There are two drainage procedures that a patient can undergo, including:

• Stent ureter. The doctor will insert a tube into the ureter to drain urine from the kidneys to the bladder. This hose will be installed on the part that is affected by the stricture.
• Percutaneous nephrostomy. The doctor inserts a tube through the back using a needle to drain the urine directly.
• Catheter. A catheter tube will be inserted through the ereter to connect the bladder to the external drainage bag. This procedure may be an option for patients with poor kidney filtering function.

Most of the time, the results of the drainage procedure are only temporary. However, the results can also have permanent effects, depending on your condition.

Surgical procedure

For a more permanent result, surgical procedures can be an option. There are a number of surgical procedures that can be done to correct the 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 named tube stent in the ureter to keep it open.
• Open operation. The doctor will make an incision in your stomach to perform the operation.
• Laparoscopic Surgery. The procedure is performed by making a small incision in the abdominal area and inserting a small tube with a camera and light into the ureter to perform the operation.
• Robot-assisted laparoscopic. Robot system assistance will be carried out to perform surgery.

After surgery, you will still have to do a number of hospitalizations. Later, you will be given medication to deal with the pain from the surgery. A urine catheter will be in place for a few days to help drain urine during recovery.

The new catheter will be removed before you return home. Sometimes, there are also patients who still need to be helped with a catheter. Doctors and medical personnel will advise looking to treat him at home.

Home remedies

What treatments should be done at home to recover after ureteral stricture surgery?

After returning to the hospital, you must take a number of treatments and comply with the restrictions that have been given by the doctor. In this recovery, ask other family members or friends for help.

Some of the instructions that patients generally have to do after surgery are as follows.

• Take medication according to the doctor's prescription and rules.
• 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 as recommended by the doctor.
• Avoid swimming or bathing in hot water. You must get approval from a doctor before doing this.

If there are complaints or symptoms that come back, consult your doctor immediately to get the right treatment.