What problems can a ureteral stent address?

What is it like to live with a ureteral stent‑induced stricture? Chronic lower back and flank pain, fever, loss of appetite—pain caused by the condition is hard to put into words. Ureteral strictures have complex etiologies and can lead to varying degrees of upper urinary tract obstruction and hydronephrosis, potentially endangering the patient’s life.

Recently, the urology department of a certain hospital admitted a patient with recurrent ureteral strictures—long‑segment strictures that proved unresponsive to incision and reconstruction—and who had previously required long‑term indwelling ureteral stents. Following placement of a ureteral stent for the ureteral stricture, the patient recovered well and has since been discharged in good condition.

A middle-aged female patient had experienced recurrent right flank and abdominal discomfort for more than 10 years. She underwent two sessions of right-sided ureteroscopic lithotripsy and three procedures involving ureterotomy with stone extraction and strictureplasty. Six days prior to admission, the right flank and abdominal discomfort recurred. A urinary tract CT scan revealed severe hydronephrosis of the right kidney, leading to a diagnosis of right ureteral stricture accompanied by severe hydronephrosis. Unable to endure the burden of her illness, the patient voluntarily opted, upon admission, for resection of the affected ureter and kidney.

After a thorough review of the patient’s medical history, physical examination, and imaging studies, the physician determined that although the right kidney exhibits severe hydronephrosis, its renal parenchyma remains relatively thick, indicating that it still has functional potential. The physician recommended performing a right percutaneous nephrostomy as a first step to assess and preserve right renal function. Following the procedure, approximately 1,000 mL of urine was drained daily from the nephrostomy tube; serial urinalysis revealed normal parameters, including urine specific gravity, suggesting that the right kidney continues to function well and merits preservation.

To preserve the patient’s right renal function and achieve cure of the right ureteral stricture, following departmental discussion, it was decided to perform, in a single stage, right‑sided ureteroscopy combined with balloon dilation of the right ureteral stricture, followed by placement of a ureteral stent for the same stricture.

One month after surgery, intravenous urography demonstrated good function of the right kidney. To definitively address the ureteral stricture and prevent recurrence, multidisciplinary discussion concluded that the stricture was associated with a scar from open surgery, recurrent ureteral stone obstruction, and chronic ureteral inflammation, rendering conventional ureteral stenting ineffective. A second-stage procedure was therefore planned to place a ureteral stent for the treatment of the stricture. The operation proceeded smoothly, and the patient recovered well, being discharged three days postoperatively. Postoperative intravenous urography confirmed restoration of secretory function in the right kidney.

The ureteral stent is specifically designed to treat complex ureteral strictures. It is a self‑expanding, large‑diameter stent made of NiTi alloy. A thin polymer coating covers the stent, creating a leak‑proof conduit that prevents tissue ingrowth and early calculus formation.

Ureteral strictures have numerous clinical causes, including calculi, infections, surgical trauma, and congenital stenosis. Ureteral strictures lead to urinary tract obstruction, resulting in hydronephrosis, increased renal pelvic pressure, stone formation and infection, and impaired renal function.

Intraluminal therapeutic techniques such as balloon dilation, electrocautery, and laser therapy offer advantages including minimal invasiveness, safety, excellent efficacy, rapid recovery, and reduced discomfort. Ureteral stenting is particularly indicated for cases in which repeated ureteral strictures, long‑segment strictures, or ureteral fistulas have proven refractory to other treatments.