1) Disease description (causes and pathophysiology, main symptoms)
- Definition: Ureteral stricture is a condition in which part of the ureter, which carries urine from the kidneys to the bladder, becomes narrowed or blocked, interfering with urine flow.
- Causes: It may result from congenital abnormalities (developmental abnormalities of the ureteral muscles), or acquired causes such as trauma or scarring after abdominal or urinary tract surgery, urinary tract infections, urinary tract stones, and malignant tumors (invasion of the ureter).
- Pathophysiology: When ureteral obstruction is present, urine drainage from the kidney is impaired, causing hydronephrosis. If it persists, compression of the renal parenchyma can lead to decreased kidney function (split renal function) and an increased risk of recurrent urinary tract infections.
- Main symptoms: Flank (loin) or abdominal pain, fever (when accompanied by a urinary tract infection), pain during urination, hematuria, or frequent urinary tract infections. It may also be discovered incidentally without symptoms.
- Tests commonly used for diagnosis: Renal ultrasound (to confirm hydronephrosis), intravenous pyelography (IVP) or abdominal/pelvic CT (to identify the location of the stricture and accompanying conditions), nuclear medicine testing (to assess kidney function and the degree of urinary drainage impairment), and retrograde urography/ureteroscopy (direct visualization and attempts at treatment).
2) Treatment methods and precautions (complications and self-care)
- Conservative and medical treatment
- If an acute urinary tract infection is present, antibiotics are administered (selected according to culture results).
- Pain control (analgesics) and adequate fluid intake are recommended.
- Temporary drainage (emergency/temporary treatment)
- Percutaneous nephrostomy (nephrostomy): Drains urine directly from the kidney to the outside to control acute hydronephrosis and infection.
- Ureteral stent (urethane stent or Double-J stent): Connects to the bladder to ensure urine flow. It is generally not permanent and requires regular replacement (replacement is often recommended at approximately 2–3-month intervals).
- Endoscopic repair
- Endoscopic balloon dilatation or endoscopic incision: These are minimally invasive methods that may be effective in the short term, but recurrence rates may be high, so follow-up observation is needed after stent placement.
- Surgical treatment
- Surgery to remove the narrowed portion of the ureter and perform ureteroureterostomy, or to reimplant the ureter into the bladder (ureteroneocystostomy).
- For long defects, reconstructive surgery such as ureteral replacement using part of the small intestine (ileal ureter).
- Performed through open surgery or laparoscopic (or robotic) surgery.
- Principles for selecting treatment
- The decision is made considering the location of the stricture (upper, middle, or lower), its length (short stricture vs. long defect), the cause (trauma, postoperative causes, tumors, etc.), and the remaining kidney function.
- Precautions and complications
- If left untreated, it may lead to persistent deterioration of kidney function and chronic kidney failure.
- Complications of surgery/procedures: Bleeding, infection, ureteral perforation, recurrent stricture, and damage to adjacent organs.
- Stent-related precautions: Urinary tract irritation, hematuria, possible urinary tract infection, and the need for regular replacement.
- Self-care (after discharge)
- Visit the hospital immediately if you develop a fever, severe flank pain, a marked decrease in urine output, or significant hematuria.
- If a stent has been inserted, strictly follow the scheduled stent replacement appointments.
- Take prescribed antibiotics and analgesics as directed, maintain adequate fluid intake, and consult your treating doctor when taking nephrotoxic drugs (e.g., some antibiotics or NSAIDs).
3) Checklist before an outpatient visit (including items to prepare and points to confirm, with sample questions)
- Items/materials to prepare
- A list of all medications currently being taken (including prescription drugs, OTC drugs, herbal medicines, and supplements)
- History of previous surgeries (especially abdominal or urinary tract surgery) and major medical conditions
- Recent test results (blood tests: creatinine; urinalysis and culture results), and images from previous ultrasound, CT, or nuclear medicine tests (on CD or as photographs)
- Record of symptom changes: when the pain started, its frequency and intensity (pain score), whether fever is present, urinary characteristics (hematuria or difficulty urinating), and changes in urine volume
- Allergies (medications, contrast agents, etc.)
- A short note to share with the doctor during the outpatient visit (prepare in order of priority)
- Symptoms (when they started and how severe they are)
- Whether there is a recent history of infection or stones
- Current medications (especially whether anticoagulants are being taken)
- Possibility of pregnancy (for women)
4) Examples of general questions to ask the doctor
- "What is the suspected cause of my stricture?"
- "What treatment options do you recommend, and what are the advantages and disadvantages of each (recovery period, success rate, and complications)?"
- "If I have a ureteral stent inserted, how often does it need to be replaced? How can stent-related discomfort be managed?"
- "How likely is kidney function to recover after surgery? What are the methods for evaluating kidney function, and what is the follow-up schedule?"
- "What should I be careful about in daily life to reduce the risk of infection (or recurrent stricture)?"
5) Examples of disease-specific questions
- "How are the location and length of the stricture measured on the imaging I underwent (ultrasound/CT), and based on those findings, what specific surgery do you recommend (reconnection vs. reimplantation vs. intestinal replacement)?"
- "What is the split function of both kidneys (or the affected kidney) currently, such as the relative function shown on a nuclear medicine test? If kidney function is significantly reduced, should nephrectomy be considered?"