What to Do About Hydronephrosis Caused by Ureteral Stricture

Hydronephrosis resulting from ureteral stricture is a serious medical condition that occurs when the flow of urine from the kidney to the bladder is obstructed due to a narrowed ureter. If left untreated, it can lead to impaired kidney function or even permanent kidney damage. Fortunately, several effective treatment options are available, tailored to the underlying cause, location, and severity of the stricture.

Surgical Intervention for Ureteral Strictures

Surgery remains the primary treatment option for patients with well-defined, localized ureteral strictures—especially when kidney function is at risk. The first step involves a thorough diagnostic evaluation using imaging techniques such as CT urography, retrograde pyelography, or MRI to determine the exact site, length, and cause of the narrowing.

When Cancer Is the Cause

If the stricture is caused by a malignant tumor—such as transitional cell carcinoma of the ureter—the standard approach often involves a radical nephroureterectomy. This procedure includes the removal of the affected kidney, the entire ureter, and a portion of the bladder where the ureter connects. This comprehensive surgery aims to eliminate all cancerous tissue and prevent recurrence.

Treatment for Benign but Severe Strictures

In cases of benign conditions—such as those caused by inflammation, infection, or prior surgical trauma—if the stricture is short and isolated, reconstructive surgery may be performed. This typically involves excising the narrowed segment and reattaching the healthy ends of the ureter through a procedure known as ureteroureterostomy or ureteral reimplantation. These techniques help restore normal urinary flow and preserve renal function.

Minimally Invasive Alternatives: Stents and Nephrostomy

Not all patients are suitable candidates for surgery. For individuals with long-segment strictures, multiple obstructions, or those whose condition stems from complex causes like retroperitoneal fibrosis, pelvic malignancies, or complications from radiation or chemotherapy, less invasive approaches are preferred.

Ureteral Stent Placement

One common solution is the insertion of a ureteral stent—a flexible tube placed endoscopically between the kidney and bladder to bypass the blockage. This allows urine to drain freely, relieving pressure on the kidney and preventing further damage. Stents may be temporary or replaced periodically, depending on the patient's long-term prognosis.

Percutaneous Nephrostomy

In situations where stenting isn't feasible—due to anatomical challenges or patient health—doctors may perform a percutaneous nephrostomy. This involves placing a drainage catheter directly through the skin into the kidney under imaging guidance. It provides immediate relief of hydronephrosis and can serve as a bridge to definitive treatment or long-term management in palliative cases.

Ultimately, the choice of treatment depends on a careful assessment of the individual patient's condition, including overall health, kidney function, and the root cause of the stricture. Early diagnosis and personalized care are crucial to protecting kidney health and improving quality of life.