Ureteral stricture is an obstruction of urine flow caused by a narrowing in any part of the ureter—the tube through which urine travels from the kidney to the bladder. This condition can lead to the buildup of urine in the kidney, swelling of the kidney (hydronephrosis), and, over the long term, loss of kidney function.

In my clinical practice, I frequently encounter ureteral strictures in both children and adults.

Sometimes it is present from birth, sometimes it develops after a kidney stone, and sometimes it occurs following surgical procedures.

UPJ stricture and UVJ stricture, in particular, are the two main forms we encounter most frequently.

In this blog post, I will provide a comprehensive overview of urethral stricture from medical, clinical, anatomical, pathological, and modern surgical perspectives. It will serve as a guide that is both accessible and scientifically sound for patients and medical students.

The ureter is a tube approximately 25–30 cm long that carries urine from the kidney to the bladder.

It consists of three regions:

1. Proximal ureter (near the kidney)

2. Middle ureter

3. Distal ureter (near the bladder)

Urine leaves the kidney's collecting system and passes through the ureter to reach the bladder.

If a narrowing develops anywhere along this duct, urine flow is obstructed and pressure in the kidney increases.

Ureteral stricture is a narrowing of the inner lumen of the ureter caused by scar tissue, inflammation, or external pressure. The stricture impedes the flow of urine, causing it to accumulate in the kidney.

➡ Hydronephrosis, swelling of the kidneys

➡ Long-term loss of kidney function

➡ Pain, infection, stone formation

➡ Kidney failure in later stages

Ureteral stricture is a serious urological condition that requires treatment.

It can occur in both children and adults.

The most common cause in children:

➡ Ureteropelvic junction (UPJ) obstruction – congenital

The most common cause in adults:

➡ Ureteral stones and previous surgeries

The causes of ureteral stricture are wide-ranging. Below, I list the most current causes and those I encounter most frequently in clinical practice:

There is a structural narrowing at the junction of the kidney and the ureter.

Reason:

•Failure of the ureter’s muscle layer to develop

•Abnormal blood pressure

•Congenital segmental stenosis

If UPJ obstruction is left untreated, the kidney enlarges and loss of function occurs.

Ureteral stones irritate the ureter wall and cause scar tissue to form.

In particular:

•If the stone has been in the ureter for a long time

•If the ureter is injured while the stone is being broken up with a laser

•If the stone surgery was traumatic

The risk of narrowing increases.

Tumors in adjacent tissues can compress the ureter:

•Ovarian tumor

•Colon tumor

•Uterine tumors

•Enlarged lymph nodes

The ureter can be damaged during surgery because it runs close to the intestines, uterus, and ovaries.

In particular:

•Cesarean section

•Hysterectomy

•Over surgeries

•Pelvic lymph node dissection

Narrow-chestedness may develop afterward.

Scar tissue may develop following a severe infection.

Pelvic fractures or penetrating injuries can damage the ureter.

Radiation therapy to the pelvic region can lead to ureteral stricture in the long term.

Symptoms vary depending on the location, severity, and duration of the narrowing.

Below you will find the most common complaints:

It depends on the position; it can be sharp or wavy.

It can lead to kidney failure without any symptoms.

In my clinical practice, I perform the following tests to definitively evaluate ureteral stricture:

It indicates hydronephrosis. This is the first step in diagnosis.

It is the method that most clearly reveals the location, severity, and cause of the narrowing.

A radiation-free method that is particularly preferred for children.

It measures kidney function.

It shows the extent to which the narrowing has affected the kidney.

During an endoscopy, images are obtained by administering a contrast agent.

The interior of the ureter is directly visible.

This method is particularly useful for clarifying the diagnosis in cases of post-stone strictures.

If left untreated, ureteral stricture can, over time:

•Swelling of the kidneys

•Recurrent infections

•Stone formation

•Loss of kidney function

•Hypertension

•Even the complete loss of a single kidney

could lead to.

For this reason, “waiting and hoping it will go away” is a completely wrong approach.

Treatment of stenosis:

•Reason

•Location (upper / middle / lower ureter)

•Length

•Full or partial?

•Kidney function

It is tailored to the individual based on factors such as these.

In modern urology, six main methods are used to treat ureteral stricture:

It is the most common initial treatment.

What is it used for?

•Temporarily clears the blockage

•Reduces kidney pressure

•Helps the infection clear up

•Protects the kidney before surgery

However, it is not a permanent cure; it is only a temporary solution.

It is used for short-segment strictures.

How do you do it?

•The stricture is reached using a ureteroscope

•The balloon is inserted

•The narrowing is widened using pressure

•Next, the stent is placed

Success rate:

40–70%

Its effectiveness decreases with repeated episodes of narrowing.

⸻

The stricture is endoscopically incised using a laser or a cold knife.

Methods:

•Holmium laser endoureterotomy

•Cutting with a cold knife (Collins knife)

•Fiber cut along 12 directions

Advantage:

•Minimally invasive

•Quick recovery

•Quite effective for short, non-recurring constrictions

Success rate:

Between 60% and 90% (depending on the location of the narrowing)

Success rates are higher in cases of lower-end stenosis.

⸻

It's one of the methods I use most often, too.

Robotic surgery is the gold standard, particularly in the following situations:

•UPJ stenosis

•Mid- and upper ureteral strictures

•Post-stone narrowings with extensive scarring

•Recurrent narrowings

•Long-segment strictures

Advantages:

•High-resolution 3D image

•Excellent texture definition

•Minimal bleeding

•Precision stitching

•Surgery with 1–2 cm incisions

•Faster recovery

•Less pain

Success rate:

➡ 90–95%

Robotic surgery is currently the method with the highest success rate for treating ureteral stricture.

It is preferred at centers that do not offer robotic surgery.

The success rate is high, but it is not as precise as robotic surgery.

It is used less frequently these days.

It is used in cases of large post-traumatic defects or complex cases.

It is performed robotically or laparoscopically.

It is a permanent solution for congenital UPJ obstruction.

The narrowed section is removed and reconnected to the bladder at a new site.

The narrowed segment is completely removed, and the healthy ends are sutured together.

In cases of long-segment distal ureteral strictures, a graft from the bladder is used.

It is used in the most complex cases.

The postoperative process is as follows:

•1–3-day hospital stay

•Ureteral stent for 10–30 days

•Return to normal life within 2–6 weeks

•Follow-up CT/ultrasound in 3 months

•Full recovery within 6–12 months

With robotic surgery, this process is even faster.

The recurrence rate varies depending on the treatment:

🔹 Balloon dilation

➡ 30–60% repetition

🔹 Endoureterotomy

➡ 10–40% repetition

🔹 Robotic pyeloplasty

➡ 5–10% repetition

🔹 Ureteral reimplantation

➡ 5–15% repetition

The lowest recurrence rate is observed in robotic surgery.

The most common cause in children is UPJ stenosis.

It can be detected even in the womb.

Symptoms:

•Abdominal bloating

•Vomiting

•Frequent fever

•Developmental delay

A kidney can be saved with pyeloplasty performed at the right time.

❓ Does ureteral stricture resolve on its own?

No.

❓ Which treatment is the most effective?

UPJ stricture → robotic pyeloplasty

In distal stenosis → reimplantation

In short segments → endoureterotomy

❓ Is a stent enough?

No, it's temporary.

❓ What happens if it isn't treated?

It progresses to the point of kidney failure.

❓ Will it happen again after surgery?

With the right technique, it's unlikely.

Ureteral stricture is a serious condition that can lead to very serious consequences for kidney health. With early diagnosis and proper treatment, it is possible to fully save the kidney. In modern urology, particularly thanks to robotic surgery, both success rates have increased and patients’ recovery times have been shortened.

I always tell my patients:

“Early diagnosis of ureteral stricture saves the kidney.”

"The right surgery, however, provides a lifelong solution."