A ureteric stricture is a scar-related narrowing of the ureter, the tube carrying urine from a kidney to the bladder. It can cause flank pain, recurrent UTI, hydronephrosis or gradual loss of kidney function, but some strictures are silent. Treatment depends on where the narrowing is, how long it is, kidney function and what caused the scar. Temporary drainage may use a DJ stent or nephrostomy. Selected short strictures can be treated endoscopically, while persistent or longer strictures may need reconstruction such as pyeloplasty, uretero-ureterostomy, ureteric reimplantation, psoas hitch, Boari flap, buccal-mucosal graft ureteroplasty or ileal ureter replacement.

What is a ureteric stricture?

Scar tissue narrows the ureter and limits urine drainage. Pressure builds upstream, causing hydroureter or hydronephrosis. Chronic obstruction can reduce kidney function if it is not recognised and managed.

Symptoms

• Dull or intermittent flank/back pain.
• Pain that worsens with high fluid intake in some patients.
• Recurrent urinary infection.
• Fever with obstruction.
• Nausea or vomiting during acute obstruction.
• Hydronephrosis found incidentally.
• Declining function of the affected kidney.

Common causes

• Previous ureteroscopy, stone surgery or impacted stone.
• Pelvic or abdominal surgery, including gynecological surgery.
• Previous ureteric reconstruction.
• Radiation injury.
• Inflammation, retroperitoneal fibrosis or endometriosis in selected patients.
• Trauma or ischemic injury.

How is it evaluated?

How is treatment chosen?

DJ stent or nephrostomy: treatment or drainage?

They can protect the kidney and control infection or obstruction, but an established fibrotic scar often returns when temporary drainage is removed. In complex cases, drainage also allows infection to settle and renal function to be assessed before definitive reconstruction.

Can kidney function recover?

Recovery depends on severity and duration of obstruction, baseline renal health and infection. A renogram can estimate split renal function and drainage before deciding whether reconstruction is worthwhile.

How a reconstructive urologist maps a ureteric stricture

The ureter is a long tube, and the reconstruction depends heavily on which part is scarred. A 2-cm distal stricture near the bladder may be treated by ureteric reimplantation, while a similar proximal stricture may be suitable for uretero-ureterostomy. Longer defects can require psoas hitch, Boari flap, buccal mucosal graft ureteroplasty or, in selected extensive disease, ileal ureter replacement.

Before choosing among these, the surgeon wants to know stricture length, side, cause, kidney function and whether the ureter is completely blocked. CT urography, retrograde pyelography and/or antegrade nephrostogram can define the anatomy. A nuclear renal scan may be useful when differential function and drainage need assessment. The presence of a stent or nephrostomy can change imaging, so the chronology of every drainage procedure matters.

Temporary drainage and definitive treatment should not be confused. A DJ stent or nephrostomy can protect a kidney and treat infection/obstruction, but a fibrotic stricture may recur after the tube is removed. The eventual aim is a tension-free, well-vascularised urinary connection that preserves kidney function with as little permanent hardware as possible.

Endoscopic treatment versus reconstruction

Balloon dilatation or endoureterotomy can be useful for selected short, non-ischaemic strictures that can be crossed safely, particularly when renal function is good and there has not been extensive prior reconstruction. Success is less predictable with long strictures, complete obliteration, radiation, severe ischaemia or repeated previous endoscopic failure.

When reconstruction is required, the surgeon tries to preserve native urinary tissue. Short proximal or mid-ureteric defects may be rejoined by uretero-ureterostomy. Distal defects use ureteric reimplantation; bladder mobilisation with psoas hitch or Boari flap adds reach. Buccal-mucosal graft can augment selected longer proximal or mid-ureteric strictures, while ileal ureter or renal autotransplantation is reserved for extensive defects where simpler options cannot create a tension-free repair.

This reconstructive ladder avoids jumping directly from “stent failed” to bowel replacement. Each step is chosen according to location, length, blood supply, prior surgery and bladder and kidney function.

How stricture length and kidney function shape the plan

A short ureteric narrowing with healthy tissue on both sides can sometimes be cut out and rejoined. A distal stricture may be better treated by reimplanting the ureter into the bladder, while a longer distal defect may need a psoas hitch or Boari flap. Long proximal or complex strictures can require buccal-mucosa augmentation, bowel replacement or another specialised reconstruction.

The kidney’s function matters before undertaking major reconstruction. If the affected kidney contributes very little function, a renogram and overall clinical context help decide whether reconstructing the ureter is worthwhile. Conversely, a functioning obstructed kidney should not be left under chronic high pressure while decisions are delayed.

This is why “ureteric stricture” is not one operation. The reconstructive ladder is selected from location, length, tissue quality, previous radiation/surgery, bladder capacity and renal reserve.

What to bring for consultation

• Ultrasound, CT urography/CT abdomen or MR urography reports and images if available.
• Renogram report (DTPA/MAG3) if performed.
• Serum creatinine and recent kidney-function reports.
• Urine routine and culture reports.
• Previous operative notes, discharge summaries and pathology reports if the problem followed surgery.
• Details of any DJ stent or nephrostomy: side, date placed and last change.
• A list of current medicines and any history of radiation, stones, endoscopy or pelvic surgery.

FAQs

Related reading

• Ureteric Stricture After Surgery
• Ureteric Injury: Stent, Nephrostomy or Reconstruction?
• Ureteric Reimplantation Explained
• Boari Flap Surgery Explained
• Buccal Mucosal Graft Ureteroplasty
• PUJ Obstruction: Symptoms and Treatment
• Urologist in Latur

References

• European Association of Urology. EAU Guidelines on Urological Trauma, 2026 https://uroweb.org/guidelines/urological-trauma
• Bourillon A, et al. Ureteral stricture: current treatment algorithm and key surgical principles in the robotic upper urinary tract reconstruction era. World J Urol. 2026;44:102. PMID: 41546831 https://pubmed.ncbi.nlm.nih.gov/41546831/
• Hook S, et al. Update on ureteral reconstruction 2024. Die Urologie. 2024;63:25-33. PMID: 37989869 https://pubmed.ncbi.nlm.nih.gov/37989869/