Question Title: Restricted Ureter

I have been diagnost after an IVP with having a restricted Right side Ureter. When I looked at the X-ray the left side was working perfectly, however the right side kidney showed a lot of dye left in it
and started at the kidney about 3/4" or more at the top and gradually narrowed to a very small opening at the bottom. The urologist said that it is being constricted or narrowed becuase of one of three things
and they are scar tissue, adhesions from previous colon surgeries, or a growth either cancerous or not. I have had many tests all showing everything to be in excellent working condition, except for this one area. I was early diagnost
as having Epidydmits, which I posted on this forum back in February and later. Most of my story is there. However, now I am scheduled to see a Colon Specialist, then the Urologist wants to do day surgery and
try pushing dye up from the Bladder. I don't know what that shows??? Then take a small byopsy. If there has never been any blood in the urine through several testings of the urine does it make any sense to take
a byopsy when the growth is likely on the inside of the stomach cavity. Then he wants to insert a small tube between the bladder and the right kidney. He indicated that there will be some discomfort from time to
time??? but not very severe??? Is that usually true. He indicated day surgery about 30 minutes time. How long do the leave it in or does it need to be changed frequently? More importantly, is the a better solution than that? One that would be more permanent
such has removing the scar tissue, adhesion growth, or possible growth that is causing the constriction? I am 68 and have 20% heart damage, but am quite healthy other than my current problem. I can do work all day
such as shoveling snow for several hours or cutting grass walking behind a mower for 1 1/2 hours without any major problem. I do get short of breath if I try carrying very heavy objects, or lifting several of them
in a row. Never have had angina pain, so I can get any indication of heart stress that way. The urologist also indicated that the nerves from the ureter go to the same area of the brain as the testicles and that
is why I am getting high pain in the are of the right testicle an groin area. Nothing to do with epdidymitis as originally diagnosed. I do have heavy aching pain 24 hours a day. One Tylenol with Codine #3 is take around
midnight to help me get a decent nights sleep, but the pain remains even with that. I take 1 or two alleve during the day, but it doesn't seem to do anything at all.
It is in the same area that I had received High Intensity Radiation 19 years ago to additonally preven the spreading of the rectal cancer which they felt was totally removed. Not recomended to use High Intensity X-Rays
today if they are confident they surgically removed it all as the radiation cause many future problems as a result.
Please advise soon. I am trying to get the surgery set up as soon as possible, maybe with this coming week???
Richard M. O'Brien

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Dear Mr. O’Brien,

You have many questions and I will try to address them all.

The narrowing of the urethra you describe along with the delayed emptying of dye from the right kidney is highly suspicious for obstruction or blockage of the kidney. The goal of treatment is to relieve the obstruction to preserve kidney function. Reasons for ureteral obstruction include cancer (inside the ureter), ureteral stones from the kidney, prior instrumentation of the ureter, stricture secondary to radiation, outside compression of the ureter (i.e. cancer), and inflammatory changes in the cavity where the ureters are located (retroperitoneal fibrosis).

The genitourinary and the gastrointestinal tracts are “kissing cousins” when they start out in the embryo. They eventually form separate systems, but because they started out together, they can “feel each other’s pain” (referred pain).

The X-ray test you had (IVP) shows the ureteral anatomy from the kidney to the bladder. The ureter from the bladder to the kidney must be visualized as well. (You could have another area of blockage beyond the first stricture). A biopsy of the strictured area may be indicated, especially if there is blood in the urine or abnormal urine cytology. A ureteral stent (the tube you referred to) will be needed regardless. This will allow relief of the obstruction and healing of the ureter if the scar tissue is resected or biopsies are taken.

When the stent is placed, one end will be located in the bladder. This may irritate the bladder and give you crampy sensations (bladder spasms) and the sensation of needing to urinate frequently. You will be changing one type of discomfort for another, but with the benefit of saving the right kidney. There are medications called anti-cholinergics which should help with this pain.

From the history you have given, I suspect the narrowing may be due to changes secondary to radiation. There could be a risk of the cancer recurrence as well. Radiation changes can also predispose you to recurrent urinary tract infections.

The plan your physician has in place is a good one.

More individualized care is available at the Henry Ford Hospital and its urban campuses by calling (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians' notes and lab test results that you may be able to obtain. These will help us greatly.

HFHS M.D.-JL
*Keyword: ureteral obstruction, transitional cell carcinoma

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