Usually, they are the following:
- Ureteral atresia: ureter not formed at all during fetal life. In the majority of the cases it is accompanied with the atresia of the ipsilateral kidney, and of other structures.
- Duplication of the ureter: the ureter has a double lumen for a part or for the entire length.
- Ectopic Ureteral Orifice
- Abnormalities of ureteral position
- Obstruction of the UreteroPelvic Junction (see Conditions/Kidney)
- Obstructed MegaUreter
- Upper Urinary Tract without Obstruction
- Vesico-Ureteral Stenosis / Strictrure
- Vesico-Ureteral Reflux: This is the reflx of urine to the upper ureter and in the renal pelvis due to not good closure of the vesico-ureteral junction which acts as a valve. The treatment could be done with an endoscopic or open procedure based on the grade of reflux and the age of the patient.
- Ureterocele: It is a sacculation of the terminal portion of the ureter.
- HydroUreteralNephrosis: Is the dilatation of the ureter and the renal cavities (pelvis) due to a non mature structure formed during the fetal life or due to chronic obstruction and decompensate in the adult. In these cases we estimate the problems that this condition is causing, the function of the kidney and we proceed accordingly.
- Ureteric Stricture
- Iatrogenic Injury: Usually, traumas cause scars and scars are narrower than the original lumen. In these cases a careful imaging anatomic and functional assessment and a precise treatment plan are necessary aiming to avoid the loss of the kidney.
- Stones of the Ureter (see Conditons/Kidney)
- Compression from extra-ureteric masses (retroperitoneal fibrosis or malignant conditions of pelvis and retroperitoneal space): This is a chrnic inflammatory process of the retroperitoneal space causing compression of one or both ureters over the lower lumbar vertebrae.
There are numerous causes of retroperitoneal fibrosis in the adult (RPF). Malignant diseases (Hodgkin lymphomas, carcinoma of the breast, carcinoma of the colon should be suspected and ruled out) or inflammatory bowel disease, aortic aneurism, etc. Some medications have also been implicated such as ergot (used for migraine control).
The symptoms are non specific and include low back pain, malaise, anorexia, weight loss, and in several cases uremia.
For the diagnosis we need intravenous urography, and CT or MRI scan at least. A retrograde urogram is necessary when real function is poor and is the best way to dlimitate the length of the ureter involved. There is a medical treatment based on corticosteroids and imuune response modulators but even nowadays we do not avoid surgical treatment.
Recently this tends to be endoscopic with placement of permanent endoreteric prosthesis (stents) that are made from a special material that avoids encrustations and last for years. Also, an open procedure is possible with mobilization of the ureter(s) and wrapping them in omentum in order to protect them.
- Tumors of the Ureteral Wall (Urothelial Cancer): These tumors are made of transitional cells (urothelial cells) and are treated either endoscopically +/- stent placement +/- instillations, either with an open or laparoscopic (robotically assisted) nephro-ureterectomy and removal of a small part of the bladder as well.
Attention! The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with your physician for further evaluation.