Treatment for Ureteral Obstruction
Ureteral obstruction is treated with several types of surgery when management with drains, stents, or medicines fail. These can include the following:
- Ureteral re-implant
- Uretero-ureterostomy
- Transuretero-ureterostomy
- Ileal ureter
The type of surgery that is needed depends upon the location of the scar, the cause and the length of the scar.
Ureteral Re-Implant
This surgery is used when the stricture is close to the bladder. These strictures often result from surgical injuries or scarring, particularly from gynecologic surgery.
In a ureteral re-implant the ureter is cut where the stricture ends and the ureter is reattached to the top of the bladder. Several things can be done to bridge the gap between the ureter and the bladder, such as pulling the bladder over towards the ureter and attaching it to the muscles of the abdomen (psoas hitch) or creating a large flap of bladder to meet the ureter (Boari flap). This type of surgery is very successful.
Uretero-Ureterostomy
This surgery works well when there is a short stricture along the coarse of the ureter in the mid to upper portion of the ureter. In this surgery a short stricture is cut out, and the ureter is reattached to itself.
Trans Uretero-Ureterostomy
When the bladder is unhealthy on the side of the stricture and the ureter cannot be attached to the bladder successfully, then the ureter can be brought to the other side of the abdomen and attached to the healthy opposite ureter. This allows for healthy drainage down the normal ureter to the bladder.
Ileal Ureter
When the ureter has scar that is too extensive to manage with one of the above surgeries or the patient has conditions such as radiation damage, another option is replacing the ureter with a piece of small bowel. This segment of bowel attaches between the kidney and the bladder. This allows for easy drainage of urine into the bladder and is also very successful.
Treatment for Uretero-Pelvic Junction (UPJ) Obstruction
A UPJ (uretero-pelvic junction) obstruction is a congenital problem with the development of the ureter as it comes out of the kidney and begins to make its way to the bladder. This results in obstruction of the pelvis of the kidney from a narrowed segment of the ureter.
The simplest way to treat this is to cut the ureter internally in order to open the narrowed segment. Unfortunately this has low long-term success, especially if the kidney is very swollen.
Pyeloplasty
A procedure with a greater success is called a pyeloplasty. In this surgery, the segment of the ureter that is causing the obstruction is removed and the normal ureter is sewn to the pelvis of the kidney. This surgery can be done laproscopically or with an open incision and is very successful by either method.
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Hear From Our Patients
Pat O’Neal underwent radiation therapy when his prostate cancer spread. However, the radiation damaged his ureters (tubes that move urine from the kidneys to the bladder). He soon experienced urinary issues. After trying other treatments that negatively impacted his quality of life, he came to U of U Health for reconstructive ureteral surgery.
