Managing Ureteral Fibrosis and Stricture in Endometrial Cancer Patients

Ureteral fibrosis and stenosis?

A patient with endometrial cancer has developed ureteral fibrosis and stenosis due to radiation therapy four years ago.
Previously, a double-J stent was placed long-term (changed every three months) as a management strategy.
However, the patient has recently been hospitalized frequently due to recurrent infections, and currently, only the left kidney is functioning.
Is there any surgical option that can serve as an alternative to the double-J stent? The goal is to provide a definitive solution (or reduce the frequency and risk of infections) for the ureteral fibrosis and stenosis.
Thank you for your response, doctor!

zin, 50~59 year old female. Ask Date: 2015/09/03

Dr. Xu Weikai reply Urology

Hello, currently, the placement of double J ureteral stents is the simplest treatment option.
If there are frequent infections or if fibrosis has not been adequately improved, surgical correction may be considered (such as ureteral dilation or reconstruction).
If the fibrosis is caused by radiation therapy, the difficulty and success rate of the surgery may be reduced.
If there are any unclear points, feel free to ask again for further discussion and research.
Online responses should only be used as a reference; it is still necessary to seek medical care at a healthcare facility.
The Ministry of Health and Welfare Taitung Hospital cares about you.

Reply Date: 2015/09/03

More Info

Managing ureteral fibrosis and stricture in patients with endometrial cancer, especially those who have undergone radiation therapy, can be quite challenging. Radiation can lead to significant tissue changes, including fibrosis and strictures, which can obstruct the normal flow of urine from the kidneys to the bladder. This can result in complications such as recurrent urinary tract infections (UTIs), hydronephrosis, and ultimately, kidney damage.

In your case, it appears that the patient has been managing the condition with a double-J stent, which is a common approach to alleviate obstruction caused by strictures. However, the recurrent infections and the fact that only one kidney is functioning highlight the need for a more definitive solution.

Surgical Options
1. Ureteral Reconstruction: If the stricture is localized and not extensive, ureteral reconstruction may be an option. This involves removing the affected segment of the ureter and re-establishing continuity. This can be done using a variety of techniques, including ureteroneocystostomy (reattaching the ureter to the bladder) or using a segment of bowel to bypass the stricture (ureteral substitution).

2. Ureteral Stenting: While you are currently using a double-J stent, there are other stenting options that may provide longer-term relief. Some stents are designed to be more biocompatible and may reduce the risk of infection compared to standard stents.

3. Endoscopic Techniques: Depending on the nature of the stricture, endoscopic procedures such as balloon dilation or laser ablation may be considered. These techniques can help to widen the narrowed segment of the ureter and may provide temporary relief.

4. Nephrostomy: In cases where the ureteral obstruction cannot be effectively managed, a nephrostomy may be necessary. This involves placing a tube directly into the kidney to allow urine to drain externally. While this is not a definitive solution, it can help preserve kidney function and manage symptoms.

5. Ureteral Bypass: In some cases, a ureteral bypass may be performed, where the urine is diverted from the kidney to the bladder through an alternate route, bypassing the obstructed segment.

Considerations
Before proceeding with any surgical intervention, a thorough evaluation by a urologist or a specialist in reconstructive urology is essential. Imaging studies, such as a CT scan or MRI, can help assess the extent of the fibrosis and stricture. Additionally, the patient's overall health, kidney function, and the presence of any other comorbidities should be taken into account when planning treatment.

Conclusion
In summary, while the double-J stent has been a temporary solution, it is important to explore more definitive surgical options to address the ureteral fibrosis and stricture. A multidisciplinary approach involving urologists, oncologists, and possibly nephrologists will be crucial in managing this complex situation effectively. The goal will be to reduce the frequency of infections, preserve kidney function, and improve the patient's quality of life. It is advisable to have an in-depth discussion with the healthcare team to evaluate the best course of action tailored to the patient's specific circumstances.

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