What Is a Ureteral Catheter?

The ureteral stricture (stricture of ureter) means that the ureteral lumen is partially or completely narrower than normal due to various reasons. Although the continuity of the lumen is not interrupted, it has caused varying degrees of upper urinary tract obstruction and hydronephrosis. True ureteral stenosis is a clearly persistent and pathologically narrow lesion within the ureteral lumen, which is fixed and will never change, and can be confirmed by ureteral pyelography through ureteral intubation. Its clinical manifestations include back pain and bloating on the affected side, chills, fever, or pyuria during infection, and bilateral stenosis may appear as uremia. The purpose of treatment is to restore continuity and function of the ureteral cavity, remove obstruction, eradicate infection, save and protect renal function. When colic occurs, the symptoms should be relieved first, and then a treatment plan should be selected.

Basic Information

English name

ureter stricture

Visiting department

Urology

Common causes

Caused by inflammation, injuries, and surgical scars

Common symptoms

Ipsilateral back pain, bloating, chills, fever, or pyuria when infected, and uremic symptoms on both sides

Causes of ureteral stenosis

In addition to congenital causes, inflammation, injuries, and surgical scars are the main causes.

Clinical manifestations of ureteral stenosis

1. The affected side has low back pain, sometimes it can touch the stagnant kidney.

2. There are chills, fever, or pyuria during concurrent infections.

3. Bilateral ureteral stenosis can appear renal insufficiency, and even uremic manifestations.

Ureteral stricture

1.B-ultrasound

Visible ureteral dilatation and hydronephrosis above the stenosed segment. Know the thickness of the renal cortex.

2. Isotope kidney map

Obstructive kidney chart can be seen to understand renal function.

3. Intravenous pyelography (IVP)

Shows the degree of hydronephrosis and the narrowed area. If the upper urinary tract cannot be visualized on the affected side, it needs to be further examined in combination with other means.

4. Retrograde intubation ureter

If the ureteral catheter can pass through the stenosis, the ureteral stenosis level and stenosis length can be confirmed. If the ureteral catheter cannot pass through the stenosed segment, it can be combined with other examination methods to determine the level and possible length of the stenosed segment.

5.CT urinary tract imaging (CTU) and nuclear magnetic urinary tract imaging (MRU)

Without the use of contrast agents, both can well show the extent of ureter and renal pelvis dilatation above the obstruction site.

Diagnosis of ureteral stenosis

1. History of urinary, abdominal and pelvic surgery suggesting that the disease is possible.

2. Low back pain, cystic mass in the upper abdomen.

3.B ultrasound can find different degrees of hydronephrosis, excretory urography and retrograde pyelography, which can help confirm the diagnosis.

Differential diagnosis of ureteral stenosis

Should be distinguished from other ureteral diseases:

Tumorous ureteral stenosis

Ureteral tumors can be divided into benign and malignant according to the nature of the tumor. Benign ureteral tumors such as polyps, malignant tumors such as transitional cell carcinoma, transitional cells with squamous cell carcinoma, and mucinous carcinoma.

Clinically, ureteral tumors are rare. The age of onset is 20 to 90 years, with more men than women, about 4: 1. Primary ureteral tumors originate from the ureter itself, most of which are malignant tumors, most of which (90%) are transitional cell carcinoma.

2. Ureteral obstruction

Obstruction of the pelvic ureteral junction is a common urinary tract obstructive disease that causes hydronephrosis. The obstruction of the pelvic ureteral junction prevents the pelvic urinary urine from smoothly entering the ureter, hinders the pelvic pelvic emptying, and causes the kidney's collecting system to expand. The renal pelvis smooth muscle gradually proliferates and strengthens peristalsis to excrete urine. When the increasing amount of peristaltic force cannot overcome the obstruction, it will lead to renal atrophy and impaired renal function.

3. Ureteral cyst

A ureteral cyst causes a cystic dilatation at the end of the ureter. The diaphragm between the ureter and genitourinary sinus is not absorbed and subsides during the embryonic development period, resulting in different degrees of narrowing of the ureteral orifice. It can also be caused by weak fiber structure at the end of the ureter, excessive length of the wall section, and excessive curvature. After forming a cystic dilatation into the bladder. Early cases can be asymptomatic clinically and are often found when diagnosing severe renal abnormalities. Symptoms are mainly urinary tract obstruction, causing repeated urinary tract infections. Due to the small opening of the cyst, persistent obstruction of the ureteral orifice can cause ureter and hydronephrosis, loss of renal function, cystic obstruction of the bladder neck, dysuria or interruption of urine flow, and recurrent urinary tract infections. Sometimes a girl's cyst can prolapse out of the urethra through the bladder neck and urethra and can reset itself. But incarceration can also occur and become purple mass.

4. Radiation ureteritis

The pathological changes of radiation ureteritis include submucosal inflammatory cell infiltration, submucosal fibrosis, ulcer formation, and atypical proliferation of epithelial cells. Radiotherapy can cause radiation ureteritis in the short and long term, which can cause ureteral stenosis and upper urinary tract dilation.

Treatment of ureteral stricture

The purpose of treatment is to restore continuity and function of the ureteral cavity, remove obstruction, eradicate infection, save and protect renal function. When colic occurs, the symptoms should be relieved first, and then a treatment plan should be selected.

1. Pelvic ureteral junction is narrow

Percutaneous renal puncture can be performed by cold knife incision in the narrow part, balloon expansion and placement of the stent, and open / laparoscopic / robot-assisted laparoscopic pelvic surgery.

2. Short ureteral stenosis

A ureteroscope can be used to insert a ureteral dilatation catheter through the stenosis to expand the ureter under direct vision, leaving the DJ tube in place.

3. Stenosis of the lower ureter

Intraluminal dilatation failure can be performed by resection of the stenosis and replantation of the bladder, suspension of the psoas ureter with ureteral replantation, or bladder wall flap ureteroplasty.

4. Upper and middle ureteral stenosis

Intraluminal expansion failure, resection of the stenosed end-to-end anastomosis, and intestinal ureteral surgery can be performed after long narrow section resection.

After the ureter is formed or anastomated, an 8FD-J tube should be placed and retained for 4 to 6 weeks.