Ureteric Reconstruction (Long-Segment Stricture and Injury)

The length of the stricture alone does not mean repair is impossible. For long strictures there are techniques: a buccal mucosa patch, bridging with a bowel segment, bringing the kidney down or extending the bladder upwards. Because these are not frequently performed in routine practice, that answer is sometimes given. You are entitled to ask for your file to be reviewed.

A substantial proportion of long ureteric strictures follow injury to the ureter during another operation. We say this without blaming anyone: the ureter is a fine structure lying very close to neighbouring organs, and such injury is a recognised surgical risk. What matters now is making the right plan.

You can, and in some patients that is the right decision. But know that these are a bridge, not a solution: they bring continuous care, regular exchanges and a risk of infection. Managing like this for years is not something to accept when repair is possible in a suitable patient.

That is the aim, but the renogram gives the answer. It measures how much function the kidney retains. If part of that function is preserved, repair is meaningful. To be honest, repair restores drainage; it does not recover function already lost. That is why deciding early matters.

For very long strictures, a segment of small bowel is placed as a bridge between the kidney and the bladder. It is an effective technique but it carries permanent changes: mucus in the urine is an expected finding that does not resolve, and imbalance in blood chemistry can develop, so long-term follow-up is required. These must be discussed plainly before the technique is chosen.

In most cases yes, but scar tissue from the previous procedure makes the second repair harder and the success rate lower. That should be said plainly. Your previous operation note is the single most decisive document in planning; a plan made without knowing the technique used and how much segment was repaired is incomplete.

In patients with a single kidney both the importance of the repair and the level of caution increase, because there is no spare. That is not a reason to avoid surgery; on the contrary, kidney-preserving repair should be brought forward. Planning and follow-up are closer in these patients.

This is one of the longer recoveries in urology. The hospital stay and stent period are longer than after other operations, particularly where a bowel segment has been used and bowel function must return. Plan a generous stay and buy a changeable ticket.

Because re-stricture can develop silently. A narrowing that progresses without symptoms can damage the kidney. You therefore need to keep to the imaging schedule even when you feel well. Ask for your follow-up plan in writing: which test, how often, and who will review it.

The CT urography images themselves (not only the report), YOUR RENOGRAM RESULT, ALL PREVIOUS OPERATION NOTES, any ureterography images, renal function tests, urine culture, whether you have had radiotherapy and your medication. Without the renogram and the operation note, no serious plan can be made in these cases.