Ureteral Stricture

What is a Ureteral Stricture?

A ureteral stricture is the narrowing of the tube (urethra) that enables urination and ejaculation. It most often strikes men because their urethra is longer than the female urethra.

The condition is rare in women. It may be caused by injury or a disease that results in scarring of the urethra. However, it can also be congenital.

What are the Symptoms of Ureteral Stricture?

The symptoms of ureteral stricture may include:

  • A sudden or gradually weakening urine stream
  • Urine leakage
  • Trickling after urination
  • Spraying urine stream
  • Double urine stream
  • Frequent urination
  • Burning or discomfort while urinating
  • Interrupted urine flow
  • Discharge (may be bloody)
  • Pelvic or lower abdominal pain
  • Reduced strength of ejaculation
  • Urinary tract infections

Ureteral Stricture Causes

In rare instances, ureteral stricture is congenital and caused by incorrect embryological development. It is not completely understood why this defect can occur.

More often, ureteral strictures are caused later in life as a result of trauma to the urethra. Surgery in the area, such as ureteroscopy, hysterectomy or vascular surgery, may result in a stricture as the tissues heal. In these instances, the stricture may not occur for many years or even decades after the surgery. Sometimes urinary stones can cause scarring of the urethra and this causes the stricture. In other instances, radiation therapy to treat cancers could result in scar tissue forming and the creation of a stricture.

Sometimes infections can lead to strictures; gonorrhea, a sexually transmitted infection, is often a cause. Lichen sclerosus, a skin disease which causes white patches on the genitals, may also be responsible for ureteral stricture.

In some instances, strictures occur as a result of blunt trauma. Pelvic fractures which disrupt the urethra could result in strictures. Alternatively, blunt trauma to the perineum, which can compress the urethra, might cause the condition.

Causes of urethral scar tissue include:

How is Ureteral Stricture Treated?

After diagnosis through urine flow measurements, internal viewing with a cystoscope and an x-ray while urinating (VCUG), treatment occurs.

Treatments include:

  • Antibiotics
  • Catheter use
  • Permanent catheterization
  • Dilation procedure
  • Surgical correction
  • Stenting (rare)

When left untreated a ureteral stricture can cause a host of complications including inflammation and infection of the urinary tract.

Ureteral Stricture Prevention

In most instances, it is not possible to prevent urethral stricture. Urinary stones are perhaps the only cause of ureteral stricture which may be prevented.

Urinary stones usually occur as a result of excess calcium being secreted into the urine. To minimize this build-up of calcium, individuals could limit the amount of sodium in their diet and increase their consumption of potassium. Calcium intake should be between 1000 and 1500mg of calcium daily, which equates to around two or three portions of dairy each day. They should also avoid excessive consumption of antacids which contain calcium.

However, it’s important to note that if too little calcium is consumed, the risk of future stones developing is higher in those who have had urinary stones in the past. For this reason, it’s important to avoid cutting out all sources of calcium from your diet.

Drinking plenty of fluids – around eight to ten 300ml glasses each day – can help to prevent stones. Thiazide diuretics and potassium citrate is sometimes prescribed to people with a history of urinary stones to prevent new ones from occurring.