Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
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Ureteral strictures can show up in many ways, from sudden, severe pain to no symptoms at all. How they appear depends on how quickly the blockage happens and how narrow the ureter becomes. If a stricture forms quickly or is suddenly blocked, such as by swelling or a small stone, the symptoms are the same as those of kidney stone pain.
This pain is usually severe and sharp, spreading from the side to the groin, and may come with nausea and vomiting. The pain happens because urine backs up and stretches the kidney quickly. However, many strictures develop slowly over months or years as scar tissue forms. In these cases, the kidney may adjust to the pressure, or its filtering slows down, causing a ‘silent obstruction.’ Patients might notice vague, on-and-off dull pain in the side, especially after drinking a lot of fluids or alcohol, which increases urine flow. This is called Dietl’s crisis and is a sign of intermittent blockage.
Often, the first sign of a stricture is not pain but another problem. Urine that cannot drain well above the stricture can become a place for bacteria to grow, leading to repeated kidney infections. Patients may have fevers, chills, or even sepsis without any pain. Sometimes, a stricture is found by accident during tests for unexplained kidney problems or during scans for other abdominal issues.
The single most common cause of benign ureteral strictures in the developed world is iatrogenic injury—damage resulting from medical treatment. The ureter’s anatomical path through the retroperitoneum and pelvis places it in precarious proximity to organs frequently targeted in surgery.
Beyond surgical trauma, the pathology of stone disease itself is a significant risk factor. A stone that remains lodged in the ureter for a prolonged period creates a zone of chronic pressure and inflammation. This interaction erodes the urothelium and triggers a profound inflammatory response in the ureteral wall (ureteritis). Even after the stone is removed or passed, the resulting fibroproliferation can lead to a stricture at the site of impaction.
Systemic inflammatory conditions also pose a risk. Retroperitoneal fibrosis is a rare disorder characterized by the development of a thick, fibrous plaque in the back of the abdominal cavity. This plaque envelops the aorta and the ureters, tethering them and compressing them externally. This condition can be idiopathic (of unknown cause) or linked to certain medications and autoimmune diseases. Similarly, severe endometriosis can involve the ureter, either by external compression from endometrial implants or, rarely, by intrinsic invasion of the ureteral wall, leading to cyclical hematuria and obstruction.
Some individuals are born with anatomical variations that predispose them to the development of strictures. The most common congenital anomaly is Ureteropelvic Junction (UPJ) obstruction. In this condition, the segment where the renal pelvis joins the ureter is functionally or anatomically narrowed, often due to an aperistaltic segment of muscle or compression by an aberrant “crossing vessel” supplying the lower pole of the kidney. While usually diagnosed in childhood, many cases remain asymptomatic until adulthood.
Other congenital anomalies include megaureter (a dilated ureter due to a functional blockage near the bladder) or ureteral duplication, in which two ureters drain a single kidney, increasing the plumbing complexity and the risk of narrowing at insertion points.
The unifying biological theme across many risk factors is ischemia. The ureter’s blood supply is segmental and tenuous, derived from small feeder vessels from the renal, gonadal, iliac, and uterine arteries. These vessels run within the adventitia, the outer layer of the ureter. Any event that strips the ureter of its adventitia—such as aggressive surgical dissection—or damages the microvasculature (like radiation or diabetes) compromises oxygen delivery to the tissue.
In regenerative biology terms, ischemia halts the urothelium’s regenerative capacity and promotes myofibroblast activation. These cells deposit dense collagen scar tissue instead of healthy elastic tissue. Therefore, patients with systemic vascular disease, diabetes, or a history of extensive pelvic surgery are at a heightened physiological risk for developing strictures because their baseline capacity for tissue repair and vascular resilience is already diminished.
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Signs of a silent stricture can be subtle and non-specific. They may include a gradual rise in blood pressure (hypertension) due to kidney stress, mild fluctuating back pain that worsens after drinking lots of fluids, recurrent urinary tract infections that are difficult to clear, or unexplained fatigue associated with reduced kidney function.
Yes, especially in cases related to radiation therapy or chronic ischemia. Radiation-induced strictures are notorious for presenting 10 to 20 years after the initial treatment. The scarring process driven by poor blood supply is slow and progressive, gradually narrowing the lumen over a long period before symptoms become apparent.
Yes, endometriosis can involve the urinary tract. Endometrial tissue can grow on the outside of the ureter, causing extrinsic compression and scarring, or, more rarely, infiltrate the wall of the ureter itself. This creates inflammation and fibrosis that leads to a stricture, often coinciding with cyclical pelvic pain.
A crossing vessel is a normal artery or vein that feeds the kidney and happens to run across the ureteropelvic junction. If it is tightly positioned against the ureter, it can pinch the tube, like a kink in a hose. Over time, the constant pulsation and pressure can damage the ureter and interfere with peristaltic waves, leading to a functional obstruction.
Yes. The stones themselves cause inflammation and trauma to the ureteral lining. Additionally, procedures used to remove stones, such as ureteroscopy, carry a small risk of ureteral wall injury. Repeated instrumentation or a stone that stays stuck in one spot for a long time significantly increases the risk of scar tissue formation.
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