Ureteral Stricture Treatment

April 15, 2025

This page was reviewed under our medical and editorial policy by Kevin G. Chan, M.D., clinical professor, division of urology and urologic oncology, Department of Surgery, City of Hope^® Cancer Center Duarte

A ureteral stricture is a narrowing of the ureter — the tube that connects the kidneys to the bladder. There are a variety of treatment options for ureteral strictures. Which treatment option is best depends on factors including what caused the ureteral stricture, where it's located and whether a patient has already undergone surgery to repair the stricture.

Treatments for Ureteral Strictures

Most ureteral strictures can be treated surgically — in most cases, using a minimally invasive or robotically-assisted surgery. Minimally invasive surgery for ureteral strictures offers a wide range of benefits, including smaller incisions, fewer complications during the procedure and faster recovery times.

Ureteral Stricture Surgery

The surgical option that’s best for a patient depends on the unique diagnosis and factors. The care team will advise the patient about which may be best for him or her.

Pyeloplasty: This is a procedure in which the ureter is surgically divided at the point where the stricture is found, then reinserted into the renal pelvis. It's the standard treatment for congenital ureteral obstructions that are located at the ureteropelvic junction.

Buccal mucosal ureteroplasty: This robotic-assisted, minimally invasive surgery involves taking mucosa, or soft tissue, from the lining of the mouth to patch the area around the stricture. It's particularly beneficial when treating strictures that are in harder-to-reach areas and may otherwise have required open surgery and reconstruction.

Ureteroureterostomy: This is a procedure where the stricture is removed and the healthy ureter is reconnected. This is frequently used in the case of short strictures in the mid- to upper ureter.

Boari flap: This surgery may be recommended to treat longer strictures that are between the the mid- and lower ureter. In this procedure, the bladder may be reshaped so that it reaches upward to cover the site of the obstruction. Less often, the kidney has to be reshaped downward to help bridge the gap.

Ureteral reimplant with psoas hitch: This option is mostly used for strictures that are low and close to the bladder. The bladder is minimally reshaped so that it attaches to the psoas muscle in the back of the abdomen. This stabilizes the bladder so the ureter can be reimplanted directly into the bladder.

Ileal ureter: This treatment is for longer strictures and involves using a small portion of the bowel to connect the kidney to the bladder. This procedure is highly effective in patients who form kidney stones and have ureteral strictures from passing multiple stones, and may be a long-term cure for ureteral strictures

Ureterolysis: This surgical procedure is most often used as a final treatment option for patients who have retroperitoneal fibrosis that compresses the ureter. Most patients with retroperitoneal fibrosis are treated using steroids and internal stents, however, if this does not work, ureterolysis may be recommended.

Stent placement: This is often the first option for patients who develop ureteral strictures. A plastic or metal tube is placed into the ureter to allow urine to bypass the stricture. These stents must usually be replaced every four to six months. Some patients may choose this option over surgery due to their overall health or their treatment preferences.

What to Know Before Treatment

Patients who are diagnosed with a ureteral stricture should talk to their care team about the steps they may need to take before undergoing treatment. These may include:

• Undergoing imaging tests, such as computed tomography or retrograde pyelography, to determine the size, extent and location of the stricture
• Tests to check kidney function or obstruction, including nuclear renal scanning
• Special steps for patients who have previously had a malignant tumor may include a biopsy of the stricture
• Other imaging tests to gather a fuller picture of the anatomy surrounding the ureter
• For some patients, antibiotics or other steps to prepare the bowel before surgery
• Tests to ensure that patients’ urine shows no signs of an infection

Ureteral Stricture Treatment at City of Hope

The expert surgeons and physicians at City of Hope treat most ureteral strictures using robotic surgery techniques. During a robotic- or open-assisted surgery, the procedure is performed using robotic medical instruments through a small incision. Our experts aim to help patients preserve quality of life and recover as quickly as possible.