A ureteric stent can bypass a narrowing and protect the kidney, but it does not permanently cure every ureteric stricture. If a stent cannot cross the scar, fails to drain the kidney, repeatedly blocks, causes unacceptable symptoms, or the obstruction returns after it is removed, the stricture needs re-evaluation. The next step may be nephrostomy drainage, an antegrade/retrograde attempt to cross the narrowing, selected endoscopic dilatation or incision, or definitive ureteric reconstruction. The choice depends on stricture length, location, cause, kidney function and the condition of the surrounding ureter.

A stent is often a drainage treatment, not a scar cure

A JJ stent creates an internal channel from kidney to bladder. It can relieve pressure, allow infection to settle and protect kidney function. In some short, fresh or partial injuries, stenting may permit healing. In a mature fibrotic stricture, however, the scar can simply narrow again after the stent is removed. Stent discomfort by itself is not proof that drainage has failed; persistent hydronephrosis, infection, rising creatinine or an incorrectly positioned or blocked stent are more important warning clues.

Different ways a stent can “fail”

• The stent cannot be passed across a complete or very tight narrowing.
• The kidney remains hydronephrotic despite the stent.
• The stent blocks with encrustation, debris or infection.
• Pain, frequency or haematuria makes long-term stenting intolerable.
• The ureter closes again soon after stent removal.
• Repeated stent exchanges become the only way to maintain drainage.

What if the stent cannot cross the stricture?

A percutaneous nephrostomy can drain the kidney directly through the back. Through that tract, an antegrade study can define the upper end of the stricture and an antegrade guidewire attempt may sometimes meet a retrograde wire from below (a rendezvous technique). If the stricture is completely obliterated or too long, forcing repeated endoscopic passage is avoided and reconstruction is planned.

What if hydronephrosis continues despite a stent?

Persistent dilation does not always mean the stent is failing, because hydronephrosis can take time to improve. But persistent pain, infection, declining kidney function or worsening dilation requires checking stent position and patency. CT, ultrasound, renal scan or contrast studies may be used depending on the situation.

Can balloon dilatation or endoscopic incision help?

Selected short, non-obliterative benign strictures may respond to endoscopic dilatation or incision, usually with temporary stenting afterward. Outcomes are less reliable in long, ischaemic, radiation-induced or repeatedly treated strictures. Endoscopic treatment should not become an indefinite cycle when the scar repeatedly returns.

When is reconstruction considered?

Definitive reconstruction is considered when the stricture is long, dense, recurrent, complete, associated with poor tissue, or dependent on repeated drainage. Surgery replaces or augments the scarred segment so urine can pass without a permanent stent.

What reconstruction might be needed?

• Ureteroureterostomy for selected short upper/mid defects.
• Ureteric reimplantation for distal disease.
• Psoas hitch or Boari flap for a longer lower/mid defect.
• Buccal mucosa graft ureteroplasty for selected long proximal/mid strictures.
• Ileal ureter or renal autotransplantation for rare extensive defects.

What if the kidney function is already poor?

A renal scan can show the contribution of the affected kidney. Temporary nephrostomy drainage may occasionally be used to see whether function improves before committing to a complex reconstruction. When function is extremely poor and unlikely to recover, nephrectomy may be discussed instead of major reconstruction in selected patients.

Can someone live with a long-term ureteric stent?

Long-term stenting is sometimes chosen when surgery is unsuitable or declined, but it requires planned exchanges and monitoring for infection, encrustation, migration and stent symptoms. It is usually not the preferred lifelong solution for a fit patient with a reconstructable benign stricture.

What to bring for consultation

• CT urography/CT KUB images.
• Ultrasound showing hydronephrosis.
• Renal scan if performed.
• Stent insertion and exchange records, including sizes if available.
• Urine culture and creatinine/eGFR.
• Previous ureteroscopy, stone surgery or abdominal/pelvic operation notes.

Why stent dependence is an important clue

If symptoms and hydronephrosis recur every time the stent is removed, the patient may be “stent dependent.” This means drainage is being maintained mechanically but the underlying scar remains. In a fit patient with a benign stricture, repeated exchanges should prompt a discussion about whether definitive reconstruction can remove the need for a permanent foreign body.

Why repeatedly forcing a wire through a complete scar can be harmful

A completely obliterated ureter is not simply a tight tube. Aggressive attempts to cross it can create a false passage or perforation without restoring durable continuity. When antegrade and retrograde imaging show a long complete block, temporary nephrostomy drainage and planned reconstruction are often safer than repeated traumatic attempts.

How the kidney is protected while planning surgery

The priority is reliable drainage. A nephrostomy can control infection, preserve function and allow urine cultures to be treated before reconstruction. It also permits antegrade contrast studies and gives the ureter time to rest. Once the kidney is safe, the surgeon can decide whether endoscopic treatment is reasonable or whether a reconstructive procedure offers the better long-term route.

FAQs

Related reading

• Ureteric Stricture: Can It Damage the Kidney?
• How Is the Type of Ureteric Reconstruction Decided?
• Recovery After Ureteric Reconstruction
• Can Ureteric Stricture Come Back After Surgery?
• Nephrostomy Tube: Patient Guide
• Urologist in Latur

References

• European Association of Urology. EAU Guidelines on Urological Trauma: Ureteral Trauma, 2026 https://uroweb.org/guidelines/urological-trauma/chapter/urogenital-trauma-guidelines
• Bourillon A, Peyronnet B, McGuire BB, et al. Ureteral stricture: current treatment algorithm and key surgical principles in the robotic upper urinary tract reconstruction era. World J Urol. 2026;44(1):102. doi:10.1007/s00345-025-06181-4.
• Fuller TW, Daily AM, Buckley JC. Robotic Ureteral Reconstruction. Urol Clin North Am. 2022;49(3):495-505. doi:10.1016/j.ucl.2022.05.002.