Ureteral Stricture Clinical Presentation

Updated: Mar 11, 2021
  • Author: Benjamin Newell Breyer, MD, MS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Presentation

History

Obtain a detailed patient history and pay particular attention to symptoms during periods of diuresis (eg, after ingestion of caffeinated or alcoholic drinks). Take note of any history of prior malignancy, surgery, or radiation therapy. Important physical examination findings include abdominal pain, fullness or tenderness, and costovertebral angle tenderness.

Ureteral strictures are often found during routine follow-up imaging after ureteroscopy or intestinal urinary diversion. In this setting, asymptomatic hydroureteronephrosis proximal to the site of obstruction may occur. Most patients with significant strictures after ureteroscopy are symptomatic. They present with flank pain, flank fullness, or abdominal fullness.

In a review of 131 patients who underwent ureteroscopy and follow-up radiographic imaging, Karod et al found no asymptomatic patients with residual obstruction. [7]  Thirteen of 21 patients with persistent flank pain had residual obstruction, one from a ureteral stricture.

Less frequently, persistent urinary tract infection or pyelonephritis is associated with unilateral ureteral obstruction. Patients with preexisting renal insufficiency or an abnormal contralateral kidney may present with an increased serum creatinine level or azotemia. Also, patients with strictures in solitary or functionally solitary kidneys (eg, renal transplant patients) may present with renal failure.