Ureteral Stricture Surgery (Ureteroplasty)
The ureters are the tubes that carry urine from the kidneys to the bladder. Scar tissue may form in a ureter after an accident or surgery. Or it may form because of a health problem such as endometriosis or cancer. Scar tissue narrows the ureter. This is called a stricture. Urine then can’t flow down the ureter properly and backs up into the kidney. This may cause pain. It can also lead to urinary tract and kidney infection or kidney damage. Ureteroplasty is surgery to remove the stricture.
Preparing for surgery
Prepare for the surgery as you have been told. In addition:
Tell your doctor about all medicines you take. This includes prescription, over-the-counter, and any herbs or other supplements. It also includes any blood thinners, such as warfarin, clopidogrel, or daily aspirin. You may need to stop taking some or all of them before surgery, as directed by your doctor.
Follow any directions you are given for taking medicines and for not eating or drinking before surgery. This includes any instructions for bowel prep.
Two types of surgery
The surgery may be done through several small incisions (laparoscopy). Or it will be done through one larger incision (open surgery). Laparoscopy cannot be used in all cases. In some cases, your doctor may start the surgery using laparoscopy but must change to open surgery for safety reasons. You and your doctor will discuss your options.
For laparoscopy, the doctor makes several small incisions in the abdomen. The scope is put through one of the small incisions. The scope sends pictures from inside the abdomen to a video screen. Surgical tools are placed through the other incisions. The surgeon may use a technique called robotic laparoscopy. The robotic system gives a 3-D view inside the body. It also assists the surgeon’s hand movements.
For open surgery, one larger incision is made in the side over the ribs, or in the abdomen. The doctor sees and works through this incision.
The day of surgery
The surgery takes about 2 to 4 hours. Afterward, you’ll stay in the hospital for 1 to 3 nights.
Before the surgery begins:
An intravenous (IV) line is put into a vein in your arm or hand. This line delivers fluids and medicine (such as antibiotics).
You may get medicine to prevent blood clots.
To keep you free of pain during the surgery, you’re given general anesthesia. This medicine allows you to sleep comfortably through the surgery. A tube may be inserted into your throat to help you breathe.
You may have an epidural to help control post-surgery pain. A small tube is inserted into your back to deliver pain medicine that numbs the lower body. Talk to your doctor or anesthesiologist about this option.
A thin tube (catheter) is placed into your bladder through the urethra. This drains urine during the surgery and for a time afterward.
During the surgery:
The narrowed portion of the ureter is cut out. If a large section is removed, tissue is used to repair the ureter. This tissue is taken from another part of the body, such as the bladder. The cut ends of the ureter are then stitched together. These stitches will dissolve over time.
A long, flexible tube called a stent is put into the ureter. It reaches from the kidney into the bladder. It is kept in place for 4 to 6 weeks after surgery to help hold the ureter open while it heals.
When the surgery is done, all tools are removed. The incision or incisions are closed with sutures, staples, surgical glue, or strips of surgical tape. One or more tubes (drains) may be placed near the incision or incisions. These drain fluid that can build up after surgery.
Recovering in the hospital
After the surgery, you will be taken to a recovery room to be monitored as you wake up from the anesthesia. You may feel sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. When you are stable, you will be taken to your hospital room. While in the hospital:
You will be given medicine to manage pain. Let your providers know if your pain is not controlled.
The catheter in your urethra and any drains will likely be removed before you go home. If not, you will be told how to care for them at home.
Recovering at home
After your hospital stay, you will be released to an adult family member or friend. Have someone stay with you for the next few days, to help care for you. Recovery time varies for each person. Your doctor will tell you when you can return to your normal routine. Until then, follow the instructions you have been given. Make sure to:
Take all medicine as directed.
Follow your doctor’s guidelines for showering. Avoid swimming, bathing, using a hot tub, and other activities that cause the incision to be covered with water until your doctor says it’s OK.
Don't lift anything heavy or do strenuous activity, as directed.
Don't drive until you are no longer taking prescription pain medicine and your doctor says it’s OK.
Don't strain during a bowel movement. If needed, take stool softeners as directed by your doctor.
The stent in your ureter will cause the urge to pass urine more often. You may also have some burning and blood in your urine. This is normal and will go away once the stent is removed during a follow-up visit.
When to call your healthcare provider
Call your healthcare provider right away if you have any of the following:
Chest pain or trouble breathing (call 911)
Fever of 100.4°F (38°) or higher, or as directed by your healthcare provider
Symptoms of infection at an incision site such as increased redness or swelling, warmth, worsening pain, or foul-smelling drainage
Abdominal or kidney pain that won’t go away with pain medicine
Blood clots in the urine
Swelling of the legs
Vomiting that doesn’t go away
The catheter becomes blocked or is pulled out
Follow up with your doctor, or as advised. If sutures or staples need to be removed, this is done 1 to 2 weeks after surgery. The stent in the ureter will be removed in 4 to 6 weeks. About 3 months after surgery, you may have an imaging test. This checks that the ureter is open and the kidney is working normally.
Risks and possible complications
Bleeding (may require a blood transfusion)
Urine leakage from the ureter or bladder
Stricture returning after surgery
Risks of anesthesia (the anesthesiologist will discuss these with you)
September 16, 2017
Placement and management of indwelling ureteral stents, Up To Date, Surgical repair of an iatrogenic ureteral injury, Up To Date
Greenstein, Marc, DO,Sather, Rita, RN