Post-Radical Hysterectomy Complications: Ureteral Stricture - Obstetrics and Gynecology

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After a radical hysterectomy, complications can arise, including ureteral stricture, which is a narrowing of the ureters that can impede urine flow from the kidneys to the bladder. This condition can lead to significant urinary issues, including the inability to urinate independently, as you have experienced.
Ureteral strictures can occur for several reasons following a radical hysterectomy. The surgical procedure involves the removal of the uterus, cervix, and surrounding tissues, which can include the ureters. If the ureters are inadvertently damaged during surgery or if scar tissue forms as part of the healing process, this can lead to strictures. Scar tissue, or fibrosis, can develop in the area where the ureters were manipulated or near the surgical site, leading to a narrowing that obstructs urine flow.

It is not uncommon for patients who have undergone radical hysterectomy to experience ureteral strictures, although the severity and frequency can vary from person to person. In some cases, strictures may develop shortly after surgery, while in others, they may take months or even years to manifest. The need for regular DJ (double-J) stent placements every two months indicates that the strictures are significant enough to require intervention to maintain urinary drainage.

The management of ureteral strictures typically involves procedures to relieve the obstruction. DJ stenting is a common temporary solution that allows urine to bypass the narrowed area and drain from the kidney to the bladder. However, this is not a permanent fix, and further evaluation is often necessary to determine the underlying cause of the stricture and to explore more definitive treatment options.

If the strictures are due to scar tissue, options may include ureteral dilation, which involves stretching the narrowed area, or ureteral reimplantation, where the ureter is surgically repositioned to alleviate the obstruction. In some cases, a ureterostomy may be necessary, where the ureter is brought to the surface of the abdomen to allow urine to drain externally.

It is essential to maintain open communication with your healthcare provider regarding your symptoms and the frequency of your DJ stent placements. Regular follow-up appointments and imaging studies, such as ultrasounds or CT scans, may be necessary to monitor the condition of your ureters and to assess the effectiveness of any interventions.

In summary, while ureteral stricture is a potential complication following a radical hysterectomy, it is not an inevitable outcome for every patient. However, if it does occur, it can lead to significant urinary issues that require ongoing management. If you have concerns about your condition or the frequency of your DJ stent placements, I encourage you to discuss these with your urologist or the surgeon who performed your hysterectomy. They can provide you with tailored advice and treatment options based on your specific situation.