Ureteroscopic management of ureteral and ureteroenteral strictures

A ureteral stricture is defined as a narrowing of the ureter causing a functional obstruction. These strictures can be congenital, acquired, or iatrogenic. Congenital ureteral strictures are commonly located at the ureteropelvic junction (UPJ). Excluding these primary UPJ strictures, most ureteral strictures are acquired and usually iatrogenic. General surgical and gynecologic procedures generally have been regarded as common causes of ureteral injury and strictures (Box 1). Urologic procedures were not a major cause of ureteral injuries before the introduction of the rigid ureteroscope in 1980 by Perez-Castro Ellendt and Martinez-Pineiro [1]. It is now recognized that ureteral injury may occur during endoscopic renal or ureteral surgery, or during open surgery. Other causes include passage of urinary calculi, radiation therapy, retroperitoneal fibrosis, and congenital abnormalities [2]. Ureteroenteric strictures occur in 4% to 8% of patients undergoing urinary diversion [3]. Before the development of currently used, minimally invasive techniques, ureterointestinal strictures were managed with exploratory laparotomy and ureteral reimplantation into the intestinal conduit. Endoscopic and radiologic technical advances have made minimally invasive approaches possible. These new techniques allow for decreased patient morbidity, decreased operating time, and decreased hospital stay, which can result in decreased cost compared with open ureteral reimplantation [4].