What is a ureteral stricture?
A ureteral stricture is a narrowing of the ureter — the tube that carries urine from the kidney down to the bladder. When the ureter becomes blocked or narrowed, urine backs up into the kidney (a condition called hydronephrosis), which can damage kidney function over time.
Ureteral strictures can occur at any point along the ureter and on one or both sides. They are most commonly caused by prior surgery, injury, radiation therapy, stone disease, or endoscopic procedures. Early diagnosis and treatment are important to protect kidney function.
Why timely treatment matters
A ureteral obstruction that goes untreated can lead to progressive and irreversible kidney damage. Even a partially obstructed ureter can silently reduce kidney function over months to years. If you've been told you have hydronephrosis or a ureteral blockage, prompt evaluation is important.
Recognizing a ureteral stricture
Ureteral strictures can be surprisingly silent — some patients have no symptoms at all and are diagnosed incidentally on imaging. When symptoms are present, they may include:
How is it diagnosed and assessed?
A thorough evaluation determines the location and length of the stricture, the degree of kidney involvement, and the best treatment approach.
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CT Urogram
Cross-sectional imaging of the entire urinary tract. Identifies the location of obstruction, degree of hydronephrosis, and any associated findings such as stones or masses.
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Nuclear Renal Scan (MAG3 or DTPA)
Measures how well each kidney is functioning and draining. Essential for determining whether the affected kidney has preserved enough function to justify repair versus removal.
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Ureteroscopy
Endoscopic evaluation of the ureter with a small camera, allowing direct visualization of the stricture and biopsy if malignancy is suspected.
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Retrograde Pyelogram
Contrast study performed through a cystoscope to outline the ureter and precisely characterize the location and length of the stricture.
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Blood and Urine Labs
Creatinine and GFR to assess overall and differential kidney function. Urine culture to rule out active infection prior to any intervention.
Temporizing and conservative approaches
While most ureteral strictures ultimately require surgical correction, several minimally invasive options can provide temporary relief or serve as a bridge to definitive repair.
Ureteral Stent Placement
A small plastic stent is placed inside the ureter to keep it open and allow urine to drain from the kidney. Stents require regular exchange (typically every 3–6 months) and are generally not a permanent solution, but are commonly used while planning definitive repair or in patients who are not surgical candidates.
Percutaneous Nephrostomy Tube
In cases of severe obstruction or infection, a drainage tube may be placed directly into the kidney through the skin under imaging guidance. This provides immediate relief and protects kidney function while a definitive plan is made.
Endoscopic Balloon Dilation
Balloon dilation of the strictured ureter can be performed endoscopically. Success rates vary by stricture cause and length, and are generally lower than surgical repair. May be appropriate for short, benign strictures in selected patients.
Definitive ureteral repair
Important: Stents Must Be Removed Before Surgery
If a ureteral stent is currently in place, it must be removed at least 2 weeks before surgery. Stents can stretch or mask the area of narrowing, making accurate identification and repair more difficult. Removing the stent allows inflammation to settle, improving tissue quality and the accuracy of preoperative planning. Dr. Wiegand will coordinate stent removal as part of your surgical preparation.
The right surgical approach depends on the location, length, and cause of the stricture, as well as prior treatments. Dr. Wiegand performs the full range of ureteral reconstructive procedures — robotically whenever possible — with the goal of durable, long-term correction that preserves kidney function.
Ureteroureterostomy
The strictured segment is excised and the healthy ends of the ureter are reconnected directly. Best suited for short strictures in the mid or upper ureter. Typically performed robotically with excellent long-term results.
Ureteroneocystostomy (Reimplantation)
For strictures of the lower ureter near the bladder, the ureter is disconnected and reimplanted into a healthy portion of the bladder. Often combined with a psoas hitch or Boari flap to bridge longer gaps. Commonly performed robotically, including with the da Vinci SP single-port system.
Psoas Hitch / Boari Flap
Techniques that use the bladder itself to bridge longer gaps in the lower ureter. The bladder is anchored to the psoas muscle (psoas hitch) or a flap of bladder is created and tubularized (Boari flap) to reach higher on the ureter. Allows reconstruction of longer strictures without tension on the repair.
Buccal Graft Ureteroplasty
Tissue from the inside of the cheek (buccal mucosa) is used to patch or reconstruct the ureter — a technique borrowed from urethral reconstruction and applied to the ureter for strictures not amenable to resection and reconnection. Dr. Wiegand has experience with this advanced approach, which is performed at relatively few centers.
Ileal Ureter (Bowel Interposition)
For very long or pan-ureteral strictures — most commonly from radiation — a segment of small intestine (ileum) is used to replace the damaged ureter entirely. A complex but highly effective option for appropriately selected patients when no other reconstruction is feasible.
Renal Autotransplantation
In selected cases, the kidney is surgically repositioned lower in the pelvis and reconnected to blood vessels and the bladder — effectively eliminating the damaged ureter entirely. Reserved for complex cases where other reconstructive options have failed or are not possible.
Nephrectomy
If kidney function is very poor and reconstruction is not possible or safe, removal of the kidney may be the most appropriate option. Dr. Wiegand will always pursue every reconstructive avenue before recommending nephrectomy, and will obtain nuclear renal scan data to objectively assess whether the kidney is worth saving.
What to expect after robotic ureteral reconstruction
Recovery varies by the specific procedure performed, but most patients undergoing robotic ureteral reconstruction follow a similar course. Your specific instructions will be reviewed at discharge.
After Robotic Ureteral Reconstruction
Dr. Lucas Wiegand · Florida Reconstructive Urology · (877) 876-3627
Hospital Stay & Activity
- • Most patients stay 1–3 nights in hospital
- • Pain managed with oral medications
- • Resume light activity in 2–4 weeks
- • Avoid heavy lifting or strenuous activity during recovery
Tubes & Stents After Surgery
- • Ureteral stent (internal) — keeps ureter open during healing, removed 3–4 weeks after surgery
- • Foley catheter — removed 1–7 days after surgery
- • Surgical drain — removed before discharge or within a few days
- • Nephrostomy tube (if placed) — removed after stent once healing is confirmed
Why a Nephrostomy May Be Needed
- • Ureter is completely blocked
- • Kidney needs to drain before or after surgery
- • High risk of urine leak or infection
- • Repair site needs rest during healing
Call Our Office If You Have
- • Fever >101°F
- • Severe or worsening pain
- • Nausea, vomiting, or inability to urinate
- • Redness, swelling, or drainage from surgical sites
Follow-up imaging (ultrasound, CT, or X-ray) may be used to confirm the repair is open and the kidney is draining well.
Concerned about a ureteral blockage?
Early evaluation protects kidney function. Dr. Wiegand offers consultations and second opinions for ureteral stricture patients.
Request a Consultation