Ureteral Stricture Disease
Expert Evaluation and Surgical Reconstruction
Ureteral stricture disease is a condition in which scar tissue causes narrowing of the ureter—the tube that drains urine from the kidney to the bladder—leading to impaired urine flow and potential kidney damage. Ureteral strictures may be asymptomatic initially but can progress over time, making timely diagnosis and expert management essential.
Dr. Alex J. Vanni is a nationally recognized reconstructive urologist with expertise in the evaluation and surgical management of complex ureteral strictures, including strictures related to prior surgery, radiation, stone disease, and iatrogenic injury. Patients are referred nationally for durable reconstructive solutions that preserve renal function and restore urinary drainage.
Ureteral Stricture Educational Video
What Is a Ureteral Stricture?
A ureteral stricture occurs when fibrosis or scarring narrows the ureter, obstructing the normal flow of urine from the kidney to the bladder. Obstruction can lead to hydronephrosis, infection, pain, and progressive loss of kidney function if not addressed.
Ureteral strictures may involve:
Proximal Ureter
Near the kidney
Mid-Ureter
Central portion
Distal Ureter
Near the bladder
Location, length, and cause are critical in determining optimal treatment.
What Causes Ureteral Stricture Disease?
Common causes include:
- Prior pelvic or abdominal surgery
- Ureteral injury during gynecologic, colorectal, or urologic procedures
- Ureteroscopy or stone-related instrumentation
- Pelvic radiation therapy
- Chronic inflammation or infection
- External compression or fibrosis
Some strictures are identified incidentally on imaging performed for other reasons.
Symptoms of a Ureteral Stricture
Symptoms vary depending on severity and may include:
- Flank or abdominal pain
- Recurrent urinary tract infections
- Nausea or vomiting
- Hematuria (blood in urine)
- Decline in kidney function
- Asymptomatic hydronephrosis detected on imaging
Because symptoms can be subtle, imaging and functional testing are often essential.
How Is Ureteral Stricture Diagnosed?
A comprehensive evaluation is necessary to define anatomy, function, and etiology. This may include:
- Review of prior surgeries, radiation, and interventions
- Laboratory assessment of kidney function
- Cross-sectional imaging (CT or MRI urography)
- Nuclear renal scan to assess differential kidney function
- Retrograde or antegrade imaging to define stricture length and location
Accurate characterization is essential before selecting definitive treatment.
How Is Ureteral Stricture Disease Treated?
Management depends on stricture length, location, cause, prior treatments, and kidney function.
Temporizing Measures
- Ureteral stenting
- Percutaneous nephrostomy
These measures restore drainage but are not definitive long-term solutions.
Definitive Surgical Reconstruction
Patients with recurrent, long, or complex ureteral strictures often benefit from reconstructive surgery.
Dr. Vanni specializes in advanced ureteral reconstruction, including:
- Ureteroureterostomy (direct reconnection)
- Ureteral reimplantation (with or without psoas hitch or Boari flap)
- Buccal mucosa graft ureteroplasty
- Robotic and open reconstructive approaches
The goal of surgery is to relieve obstruction, preserve kidney function, and provide durable long-term drainage.
Why Experience Matters in Ureteral Reconstruction
Ureteral reconstruction is technically demanding and outcomes depend on:
- Accurate preoperative assessment
- Thoughtful selection of reconstructive technique
- Expertise in managing radiation-associated or redo cases
High-volume reconstructive experience improves durability and reduces the need for repeated interventions.
Dr. Vanni's outcomes reflect a commitment to technical excellence, patient safety, and long-term preservation of renal function, even in complex cases.
National Referral Center for Complex Ureteral Strictures
Patients with recurrent or complex ureteral strictures—including those related to prior surgery or radiation—are referred nationally to Dr. Vanni for expert consultation and definitive reconstruction. He works closely with referring physicians to ensure coordinated care and long-term follow-up.
Have Questions About Ureteral Stricture?
Get answers to the most common questions about ureteral stricture treatment, surgery, and recovery.
View Frequently Asked QuestionsUreteral reconstruction outcomes are supported by peer-reviewed studies demonstrating the superiority of open and minimally invasive reconstructive techniques over temporizing measures, and Dr. Vanni's practice aligns with current evidence-based guidelines.
Treatment Outcomes at a Glance
Success Rate
90–95% success with ureteroureterostomy; 80–90% for complex reconstructions
Surgery Duration
2–4 hours depending on complexity and approach
Recovery
Gradual return to full activity over 4–6 weeks
Schedule a Consultation
If you have been diagnosed with a ureteral stricture, hydronephrosis, or have declining kidney function, expert evaluation can help determine the most effective and durable treatment approach.