Stricture Ureter — Re-implantation & Dilatation Treatment in Andheri, Mumbai
A ureteric stricture is a narrowing of the tube that carries urine from the kidney to the bladder. This narrowing may develop due to previous surgery, injury, infection, stone-related scarring, radiation, or congenital abnormalities. It can restrict urine flow and lead to flank pain, recurrent urinary infections, kidney swelling, or reduced kidney function. Dr. Ashish Gupta provides a detailed evaluation using imaging and specialised tests to identify the location, length, and severity of the stricture.
Treatment may include ureteric dilatation to widen a short or less severe narrowing, often supported by temporary stent placement. For longer, recurrent, or complex strictures, ureteric re-implantation may be recommended to reconnect the healthy ureter directly to the bladder. Dr. Ashish Gupta plans the procedure according to the patient’s condition, kidney function, and previous treatment history, with the aim of restoring smooth urine drainage and preventing further kidney damage.
Meet Dr. Ashish Gupta – Expert Urologist in Andheri, Mumbai
Dr. Ashish Gupta
What is a Ureteral Stricture?
The ureter is a slender muscular tube — approximately 25 to 30 cm long — that connects each kidney to the bladder. Its job is deceptively simple but absolutely vital: to carry urine produced by the kidney downward into the bladder through a series of rhythmic muscular contractions called peristalsis. When this tube becomes abnormally narrowed at any point along its length, urine cannot flow freely — and the consequences for the kidney can be serious.
A ureteral stricture is exactly this narrowing — a segment of the ureter where scar tissue, inflammation, or external compression has reduced the internal diameter of the tube, partially or completely obstructing the normal passage of urine. The urine then backs up into the kidney, causing progressive swelling known as hydronephrosis. Left untreated, this sustained pressure slowly but irreversibly damages the kidney’s filtering tissue, ultimately leading to permanent loss of kidney function.
Ureteral strictures can affect any part of the ureter — the upper, mid, or lower segment — and can affect one or both sides. The location, length, and underlying cause of the stricture all directly influence which treatment approach is most appropriate.
What are the Signs and Symptoms of Ureteral Stricture ?
Flank pain or loin pain — a dull, persistent aching on one side of the back, between the lower ribs and the hip; worsening when urine production is high
Recurrent urinary tract infections — bacteria thrive in stagnant urine that cannot drain freely; infections recur despite antibiotic treatment
Fever and rigors — if the obstructed kidney becomes infected (a condition called pyonephrosis), patients develop high fever, shivering, and severe flank pain — a urological emergency requiring urgent drainage
Haematuria — blood in the urine, either visible or detected on dipstick testing
Reduced urine output — if both ureters are affected or the stricture is in a single functioning kidney
How is Diagnosis of Ureteral Stricture ?
Dr. Ashish Gupta uses a thorough and systematic approach to diagnose Ureteral Stricture accurately. The diagnostic process may include:
Ultrasound of the Kidneys and Urinary Tract
The first and simplest investigation — detects hydronephrosis (kidney swelling) and sometimes reveals the level of obstruction. Does not directly visualise the ureter in most cases.
CT Urogram (CTU)
The most comprehensive single investigation — provides detailed imaging of the entire urinary tract, identifies the site and length of the stricture, detects any causative lesion such as a stone or tumour, and assesses the degree of hydronephrosis. The gold standard for anatomical assessment.
MAG3 Diuretic Renogram
A nuclear medicine scan that measures how well each kidney is functioning and how efficiently urine drains through the obstructed ureter. It answers the critical question: is this obstruction causing significant functional impairment that requires intervention? It also measures split renal function — essential for surgical planning.
Retrograde Pyelogram
A cystoscopic procedure in which contrast dye is injected directly up the ureter through a catheter placed via the bladder. It provides a precise, detailed X-ray map of the stricture — its exact location, length, and the anatomy above and below it.
Ureteroscopy
Direct visual inspection of the ureteral lumen using a small flexible or semi-rigid camera, allowing assessment of the nature and severity of the stricture from the inside.
Treatment of Ureteral Stricture — Options Offered by Dr. Ashish Gupta
Treatment of Ureteral Stricture — Options Offered by Dr. Ashish Gupta
Treatment of a ureteral stricture must address two objectives simultaneously: relieving the obstruction to protect kidney function, and correcting the underlying anatomical problem to prevent recurrence. The optimal treatment depends on the stricture’s location, length, cause, and the patient’s overall health.
1. Ureteral Dilatation — Minimally Invasive Endoscopic Treatment
Ureteral dilatation is an endoscopic technique that widens the narrowed segment of the ureter from within, using either a balloon catheter or a series of progressively larger dilating catheters.
Under general or spinal anaesthesia, a cystoscope is passed into the bladder and a guidewire is negotiated through the strictured segment of the ureter under fluoroscopic (X-ray) guidance. A balloon dilatation catheter is then advanced over the guidewire to the stricture site and inflated to a precise pressure — mechanically stretching and breaking the scar tissue to widen the ureteral lumen. A ureteral stent (DJ stent) is left in place after the procedure for 4 to 6 weeks to support healing and maintain patency.
When is dilatation appropriate? Balloon dilatation is best suited for short, non-ischaemic strictures — particularly those caused by post-ureteroscopy scarring or mild post-surgical narrowing. It is a relatively simple, day-case procedure with minimal recovery time. However, its long-term success rate for most ureteral strictures is modest — approximately 50 to 60% — and recurrence is common, particularly for longer or radiation-induced strictures. It is therefore considered a temporising measure in many cases, or a first-line option in patients not suitable for reconstructive surgery.
Endoureterotomy — A Related Technique In selected cases, rather than simple dilatation, the stricture can be incised using a laser or cold knife passed through a ureteroscope — a procedure called endoureterotomy. Like balloon dilatation, it is most effective for short intrinsic strictures and is followed by prolonged stenting.
2. Ureteral Re-implantation — Surgical Reconstruction for Lower Ureteral Strictures
Ureteral re-implantation — also called ureteroneocystostomy — is the definitive surgical repair for strictures affecting the lower third of the ureter, close to or at the bladder. It involves detaching the strictured segment of the ureter and surgically re-implanting the healthy upper end directly into the bladder at a new, unobstructed site.
This is the gold standard treatment for lower ureteral strictures because it removes the diseased segment entirely and creates a fresh, wide, unobstructed connection between the healthy ureter and the bladder. Long-term success rates exceed 90 to 95%.
Psoas Hitch When the gap between the healthy ureter and the bladder is too large for a tension-free anastomosis, the bladder is mobilised and anchored to the psoas muscle on the sidewall of the pelvis — a manoeuvre called a psoas hitch. This effectively brings the bladder up to meet the ureter, bridging a defect of up to 5 to 6 cm and allowing a tension-free re-implantation.
Boari Flap For longer lower ureteral defects — where the gap is too great even for a psoas hitch — a Boari flap is created. A tongue-shaped flap of bladder wall is fashioned and tubularised to create a tube of bladder tissue that bridges the gap between the bladder and the healthy upper ureter. This allows reconstruction of lower ureteral defects of up to 10 to 12 cm.
Anti-reflux Mechanism During re-implantation, an anti-reflux technique — creating a submucosal tunnel through which the ureter passes — is incorporated to prevent urine from refluxing back up the ureter toward the kidney during bladder filling and voiding.
Both procedures are performed laparoscopically or using robotic-assisted techniques at Dr. Ashish Gupta’s clinic in Andheri — offering the precision of open surgery through minimally invasive ports, with a shorter hospital stay, less pain, and faster recovery.
What Is Stricture Ureter Staging?
Ureteric strictures do not have an officially recognised staging system. They may be grouped by the length of narrowing, degree of obstruction, symptoms, and effect on kidney function.
Stage 1 – Mild Narrowing – A short stricture causes little obstruction and may produce mild or no noticeable symptoms.
Stage 2 – Moderate Obstruction – The narrowed ureter partially restricts urine drainage and may cause pain, infection, or kidney swelling.
Stage 3 – Severe Obstruction – A long or tight stricture significantly blocks urine flow and may begin to reduce kidney function.
Stage 4 – Complicated Stricture – Persistent blockage leads to recurrent infection, marked kidney swelling, stone formation, or kidney damage and may require re-implantation.
Stricture UreterTreatment in Andheri May Include
Ureteric Dilatation
A balloon or specialised instrument is used to gently widen a short, less severe narrowing in the ureter.
Endoscopic Incision (Endoureterotomy)
The scarred area is opened internally using a laser or fine cutting instrument to improve urine flow.
Ureteric Stent Placement
A temporary stent keeps the ureter open and supports urine drainage while the treated area heals.
Ureteric Re-implantation
The healthy ureter is surgically reconnected to the bladder when the lower ureter has a long or recurrent stricture.
Ureteroureterostomy
The narrowed section is removed, and the two healthy ends of the ureter are joined together.
Robotic or Laparoscopic Reconstruction
Selected complex strictures may be repaired through small incisions using a minimally invasive approach.
Buccal Mucosal Graft Repair
Tissue from the inner cheek may be used to reconstruct a long or difficult ureteric narrowing.
Nephrostomy Drainage
A temporary tube may be placed directly into the kidney to relieve severe blockage or infection before definitive treatment.
Frequently Asked Questions About PUJ Obstruction
A ureteral stricture is an abnormal narrowing of the ureter that restricts the normal flow of urine from the kidney to the bladder.
It may occur due to scar tissue from kidney stones, previous surgery, infection, radiation therapy, injury, or a condition present from birth.
Common symptoms include pain in the side or back, repeated urinary infections, blood in the urine, fever, nausea, and reduced urine flow.
Doctors may use ultrasound, CT urography, renal function scans, blood tests, urine tests, or endoscopic examination to locate the narrowing and assess its severity.
Yes, an untreated stricture can cause persistent urine blockage, kidney swelling, recurrent infection, and gradual loss of kidney function.
Treatment may include balloon dilatation, laser endoureterotomy, ureteric stenting, robotic reconstruction, or ureteral re-implantation, depending on the stricture’s length and location.
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