Ureteral Stricture in 3D: An Interactive Surgical Atlas

How to Use the Atlas

• Look aroundDrag to rotate. Pinch, or hold Ctrl and scroll, to zoom. Shift-drag moves the model.
• Look insideCutaway opens the model through the ureter. X-ray view shows the collecting system, ureter and bladder the way a contrast study does.
• Ask what something isClick any structure for its name and its part in the repair.

What the Seven Views Show

1. The stricture

   A ureteral stricture is scar that narrows the tube carrying urine from the kidney to the bladder. Urine backs up, and the ureter and kidney above it swell (hydronephrosis). The model shows a stricture in the lower (distal) ureter, below where it crosses the iliac vessels.

2. Ureteroureterostomy

   For a short stricture, the scarred segment is removed and the two healthy ends are opened slightly and sewn together. Ureteroureterostomy achieves 90 to 95% success for short strictures.

3. Reimplantation with psoas hitch

   For a stricture close to the bladder, the ureter is divided above it and reimplanted into the bladder. To bridge the gap without tension, the bladder is stretched up and stitched to the tendon of the psoas muscle.

4. Boari flap

   For a longer gap, a flap of bladder wall is cut, rolled into a tube and turned up to reach the ureter, which is then joined to its end. The bladder is usually hitched to the psoas as well.

5. Appendiceal onlay

   On the right side, the ureter can be opened along the stricture and the appendix, kept alive on its own blood supply, opened and laid over the gap as a patch.

6. Robotic buccal mucosa graft ureteroplasty

   For a stricture in the upper (proximal) ureter, the ureter is opened robotically along the scar and a graft from the lining of the cheek is sewn in as a patch, then wrapped with omentum, a fatty layer with a rich blood supply.

7. Ileal ureter

   When the stricture runs the length of the ureter (pan-ureteral), a segment of small intestine (ileum) is isolated on its blood supply and used to replace the ureter, from the kidney to the bladder. The bowel is rejoined behind it.

After most repairs a stent rests inside the ureter while it heals, and it is removed 4 to 6 weeks later in the office. Complex reconstructions achieve 80 to 90% success in experienced hands. See the ureteral stricture FAQs.

The Structures Involved

Ureter

The muscular tube, about the width of a pencil lead inside, that carries urine from the kidney to the bladder. It is described in thirds: proximal (upper), mid and distal (lower).

Iliac vessels

The large artery and vein to the leg. The ureter crosses in front of them at the rim of the pelvis, a useful landmark between the mid and distal ureter.

Psoas muscle

A large muscle along the spine and pelvis. Its tendon is a strong anchor for a psoas hitch.

Hydronephrosis

Swelling of the kidney and ureter above a blockage, caused by urine backing up.

This page is for educational purposes and is not a substitute for an individual medical evaluation. Reviewed by Alex J. Vanni, MD, FACS. Last updated September 19, 2026.