Endoscopic Management of Mid‐ureteral Obstruction

Abstract

Strictures of the mid ureter represent a complex diagnostic and management dilemma due to their varied etiologies and their unique physiology and anatomic relationships. They may present silently, or with acute pain and septic obstruction. Failure to diagnose and treat these strictures in a timely manner may result in renal loss. Classically, mid-ureteral strictures have been diagnosed by ultrasound, computed tomography, or magnetic resonance urography. Newer diagnostic modalities include indocyanine green and endoluminal ultrasound. Initial management for mid-ureteral strictures often requires temporary retrograde or antegrade stenting to maintain drainage. For short-length, non-ischemic strictures, endoscopic management including balloon dilation, endoureterotomy, and endoscopic realignment may be employed with reasonable success rates. Longer strictures or recurrent strictures may require more complicated laparoscopic, robotic, or even open reconstructive techniques.