Ureteral Stricture: Causes and Endoscopic Surgery Explained - Urology

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Ureteral stricture, or narrowing of the ureter, can be a significant medical issue that may arise from various causes, including inflammation, previous infections, or trauma. In your case, the history of recurrent urinary tract infections (UTIs) over the past decade could indeed contribute to the development of ureteral strictures. Chronic inflammation from repeated infections can lead to scarring and narrowing of the ureter, which may explain the findings from your imaging studies.

The ureters are the tubes that carry urine from the kidneys to the bladder, and any obstruction or narrowing can lead to complications such as hydronephrosis (swelling of the kidney due to urine buildup) and potential kidney damage if not addressed. Your doctor’s recommendation to drink plenty of water is crucial, as it helps to flush out the urinary system and can alleviate some pressure on the kidneys, even if the flow is slow.

Regarding the endoscopic surgery your doctor mentioned, this procedure is typically performed under sedation or general anesthesia. The goal is to access the ureter through a small scope (ureteroscope) that is inserted through the urethra and bladder into the ureter. Here’s a more detailed overview of the procedure:
1. Preparation: Before the surgery, you will be given instructions on fasting and may need to undergo preoperative tests. It's essential to disclose any medications you are taking and any allergies you may have.

2. Anesthesia: You will receive either general anesthesia or sedation, depending on the complexity of the procedure and your health status.

3. Accessing the Ureter: The surgeon will insert the ureteroscope through the urethra and bladder, guiding it into the affected ureter. This instrument is equipped with a camera that allows the surgeon to visualize the inside of the ureter on a monitor.

4. Identifying the Stricture: Once the scope is in place, the surgeon will assess the area of narrowing. Depending on the severity and location of the stricture, various techniques may be employed to treat it.

5. Treatment Options:
- Dilation: The surgeon may use a balloon or other instruments to gently widen the narrowed area.

- Stenting: A stent (a small tube) may be placed in the ureter to keep it open and allow urine to flow freely. This stent can be temporary or permanent, depending on the situation.

- Laser Treatment: In some cases, lasers may be used to remove scar tissue or to cut through the stricture.

6. Post-Procedure Care: After the procedure, you will be monitored in a recovery area. It’s common to experience some discomfort, which can be managed with pain medication. You may also have a stent in place temporarily, which can cause some urinary symptoms like urgency or frequency.

7. Follow-Up: Your doctor will schedule follow-up appointments to monitor your recovery and the effectiveness of the treatment. Imaging studies may be repeated to ensure that the ureter is functioning properly.

In summary, ureteral strictures can arise from various causes, including chronic infections like those you have experienced. The endoscopic surgery is a minimally invasive approach to treat this condition, allowing for direct visualization and intervention in the ureter. It’s important to discuss any concerns or questions you have with your healthcare provider to ensure you fully understand the procedure and its implications for your health.