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URETERIC STRICTURE

The ureter is the canal, through which urine flows from the kidney to the bladder. A narrowing, also called a stricture, can occur on the course of this canal.

This can be dangerous because urine can drain less well, which can lead to infections of the kidney. In the long term, it can also compromise kidney function.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Different causes of strictures:

  • External compression: pressure from surrounding structures (eg swollen lymph nodes) can cause the ureter to be narrowed.

  • Damage to the inside of the ureter:
    ° Kidney stones: If a large ureter stone has been in place for a long time, it can sometimes cause some damage to the inner lining of the ureter. This damage can then heal in turn with some scarring.
    ° Previous interventions on the ureter itself (eg ureterorenoscopy for kidney stones) or through operations on surrounding structures, scar tissue may develop as a result of damage caused. However, this is very rare.

  • Retroperitoneal fibrosis: This is proliferation of connective tissue behind the peritoneum, which in turn can narrow the ureter. This can occur after radiation (radiotherapy) in this area or can also rarely occur idiopathically (= without apparent cause).

 

If this narrowing requires treatment, there are several options.

These all aim to spare as much as possible a healthy ureter and to guarantee a smooth passage of urine to the bladder so that the kidney function is spared as much as possible.

 

  1. Balloon dilatation: an attempt is made to stretch the narrowing by inflating a balloon in the canal.

 

  1. Endoscopic incision: This involves looking into the ureter with a camera and carefully cutting open the narrowed piece of ureter. Afterwards, a stent (= internal drainage tube) will temporarily remain between the bladder and the kidney to allow the healing process.

  2. Reimplantation: if the previous options were not successful or not possible based on the findings of the urologist (eg the narrowed ureter is very long), a reimplantation will be chosen. Various techniques are known for this, the ultimate goal of which is always to re-implant the healthy ureter into the bladder. Here, too, a stent (= internal drainage tube) will be temporarily left between the bladder and the kidney.

Schermafbeelding 2021-02-03 om 09.31.20.
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