Ureteral stricture

complete detail, types and pathophysiology about ureteral stricture

1. URETERAL STRICTURE PRESENTED BY: SONIA DAGAR

2. DIAGRAMATIC VIEW OF URETERAL STRICTURE

3. A urethral stricture is characterized by a narrowing of the urethral lumen, causing functional obstruction. Most common cause of urethral stricture is ureteropelvic junction (UPJ) obstruction, which is characterized by a congenital or acquired narrowing at the level of UPJ. DEFINITION

4. After treatment for another urological condition, pelvic radiation therapy or urinary diversion surgery may develop ureteral stricture. External traumatic injury can cause strictures. In children, congenital anomalies may result in strictures. It may occur after passage of kidney stones or as result of certain cancers. pelvic fractures CAUSES AND RISK FACTORS

5. catheter insertion radiation surgery performed on the prostate benign prostatic hyperplasia a tumor located in close proximity to the urethra untreated or repetitive urinary tract infections the sexually transmitted infections (STIs) gonorrhea or chlamydia . Cont…

6. Iatrogenic : such as those caused by catheterization, instrumentation, and prior hypospadias repair. Infectious or inflammatory: caused by gonorrhoea or lichen sclerosis. Traumatic stricture : including straddle injuries or pelvic fractures TYPES OF URETERAL STRICTURE

7. Pathological analysis of the stricture reveals Disordered collagen deposition, fibrosis and varying level of inflammation The resulting urethral obstruction may vary widely from mild to severe Which cause complete obstruction and subsequent loss of renal function PATHOPHYSIOLOGY

8. Blood in the semen Bloody or dark urine Decreased urine output Decreased urinary stream Difficulty urinating Discharge from the urethra Frequent or urgent urination Urinary retention Distended (enlarge) bladder CLINICAL MENIFESTATIONS

9. Incontinence Painful urination (dysuria) Pain in the lower abdomen Pelvic pain Slow urine stream Spraying of urine stream Enlarged or tender lymph nodes in the groin area Enlarged or tender prostate Hardness on the under surface of the penis Redness or swelling of the penis Cont…

10. A detailed patient history and physical examination Urinalysis Urine culture and sensitivities Serum electrolyte with serum blood urea nitrogen and creatinine Ureteroscopy Renal ultrasonography Computed tomography Interavenous pyelography Retrograde pyelography Nuclear medicine diuretic scan DIAGNOSTIC EVALUATIONS

11. Balloon dilation Endoureterotomy Ureteral metal stents Transureteroureterostomy Ureteroneocystostomy MANAGEMENT

12. Balloon dilation : Followed by stent placement for 4-6 weeks . Endoureterotomy : Is to open a stricture in a ureter. Ureteral incisions can be performed with an endoscopic cold knife. Ureteral metal stents: it have been used to treat end stage malignant disease, provide proximal decompression.

13. It is a urinary reconstruction technique that is used to join one ureter to the other across the midline. TUU is also used in undiversion procedures when the surgeon wants to avoid the pelvis because or previous trauma, surgery or radiation therapy. Transuretrouretrostomy :

14. Ureteroneocystostomy:

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