Updates in Management of Mid Ureteric Stricture

Abstract

n understanding of the anatomic relations of the ureters is critical to the practice of urology, as well as to the disciplines of gynecologic, vascular, and general surgery. The ureter serves as a critical landmark and is intimately involved with other vessels and organs, making accidental ureteral injury a dreaded consequence of surgery. Thus it is essential that every surgeon operating in this area must be familiar with the special anatomy of the ureter Urologists divide the ureter beyond the ureteropelvic junction (PUJ) arbitrarily into the proximal, middle and distal part. According to the international anatomical terminology the ureter consists of the abdominal, the pelvic and the intramural segment. The ureter has 3 physiologic narrowings: (1) the ureteropelvic junction, (2) the crossing over the iliac vessels, and (3) the ureterovesical junction.Also,it has 5 surgical constrictions: (1) Pelviureteric junction (2) Pelvic brim (Crossing of iliac vessels) (3) Crossing of Vas deferens(♂) / Broad ligament(♀) (4) Ureterovesical junction (5) Ureteric orifice (Intravesical). The causes of uretric stricture are numerous. The widespread use of upper tract endoscopy has led to an increased frequency of iatrogenic ureteral stricture. Early ureteroscopy A  Summary Updates in Management of Mid Ureteric Stricture 145 studies reported ureteral stricture rates of 3%-11% in patients undergoing ureteroscopy for calculus management. More recent studies using smaller fiberoptic endoscopes; laser lithotripsy; and smaller, less traumatic instruments report a ureteral stricture rate of less than 1%. Ureteral strictures may be classified as extrinsic or intrinsic, benign or malignant, and iatrogenic or noniatrogenic. Intrinsic benign strictures, may be congenital (eg, congenital mid ureteric stricture), radiational fibrosis,iatrogenic, or noniatrogenic (eg, those that follow passage of calculi or chronic inflammatory ureteral involvement [eg, tuberculosis and schistosomiasis]). Intrensic mlignant stricture could be primary (TCC of the ureter) or secondries e.g from UB TCC. Ureteral strictures are typically due to ischemia, resulting in fibrosis when it follows open surgery or radiation therapy, whereas the stricture is considered nonischemic if it is caused