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Ureteral Sclerosis – Causes, Symptoms and Treatment

Ureteral sclerosis is a pathological hardening and scarring of the ureteral wall that can obstruct urine flow. It is considered a rare urological condition.

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Things worth knowing about "Ureteral Sclerosis"

Ureteral sclerosis is a pathological hardening and scarring of the ureteral wall that can obstruct urine flow. It is considered a rare urological condition.

What is Ureteral Sclerosis?

Ureteral sclerosis is a pathological condition in which the wall of the ureter -- the tube connecting the kidneys to the bladder -- becomes progressively hardened, thickened, and scarred. This fibrous transformation impairs the normal peristaltic transport of urine from the kidney to the bladder, leading to partial or complete obstruction of urinary flow.

If left untreated, the resulting backpressure of urine can cause a dangerous swelling of the kidney known as hydronephrosis, and may ultimately progress to renal insufficiency (kidney failure).

Causes

Ureteral sclerosis can arise from a variety of underlying conditions:

Chronic inflammation: Recurrent urinary tract infections or specific infections such as urogenital tuberculosis can lead to fibrous scarring of the ureteral wall.
Previous surgical procedures: Pelvic or retroperitoneal surgery, as well as urological interventions such as ureteroscopy, may leave scar tissue along the ureter.
Radiation therapy: Radiotherapy targeting pelvic tumors (e.g., prostate, cervical, or colorectal cancer) may induce fibrosis and sclerosis of adjacent ureteral tissue.
Retroperitoneal fibrosis (Ormond disease): A rare condition in which fibrous tissue forms in the retroperitoneal space and compresses the ureter from outside.
Kidney stones: Prolonged pressure from calculi or mechanical trauma during stone passage can trigger localized scarring.
Congenital anomalies: In rare cases, structural malformations of the ureter may predispose to sclerotic changes.
Autoimmune diseases: Systemic connective tissue disorders can also involve the ureter.

Symptoms

Clinical manifestations depend on the degree and location of the ureteral narrowing. Common symptoms include:

Flank or back pain on the affected side
Recurrent urinary tract infections
Reduced urine output or changes in urination
Nausea and general malaise when urinary obstruction is present
In advanced cases, signs of renal impairment such as fatigue, fluid retention, and elevated kidney function markers in blood tests

In early stages, the condition may be entirely asymptomatic and discovered incidentally during imaging studies.

Diagnosis

Several diagnostic modalities are used to confirm and characterize ureteral sclerosis:

Ultrasound: A basic first-line investigation to detect hydronephrosis or ureteral dilation.
Contrast-enhanced CT scan: Provides precise information about the location, extent, and potential causes of the stricture.
MRI: Particularly useful when retroperitoneal fibrosis or a tumor is suspected.
Ureteropyelography: Contrast X-ray imaging of the ureter to pinpoint the site of obstruction.
Ureteroscopy: Direct endoscopic visualization of the ureteral lumen, which also allows for tissue biopsy for histological examination.
Laboratory tests: Blood and urine analyses to assess kidney function and detect infection or inflammation.

Treatment

Treatment of ureteral sclerosis depends on the underlying cause, the location and severity of the stricture, and the overall health of the patient.

Conservative Management

In mild cases or as a temporary measure, a ureteral stent (a thin plastic tube) can be inserted to maintain urine drainage. Stents require regular replacement.

Surgical Treatment

Endoscopic ureterotomy: The stricture is incised using a laser or blade introduced through an endoscope.
Ureteral resection and reanastomosis: The scarred segment is surgically removed and the healthy ends are reconnected.
Ureteral reconstruction (ureteroplasty): For longer defects, the ureter may be reconstructed using a segment of small intestine (ileal interposition) or other techniques.
Nephrostomy: In cases of acute obstruction, emergency drainage directly into the renal pelvis through the skin may be necessary.

Treatment of the Underlying Condition

When retroperitoneal fibrosis or an autoimmune disorder is the root cause, treatment with corticosteroids or other immunosuppressive agents may be required.

Prognosis

The outcome of ureteral sclerosis depends largely on the underlying cause and how early treatment is initiated. With timely intervention, kidney function can often be preserved or restored. Without treatment, there is a significant risk of permanent kidney damage or loss. Regular urological and nephrological follow-up is essential after therapy.

References

Wein, A.J. et al.: Campbell-Walsh Urology. 11th Edition. Elsevier Saunders, Philadelphia, 2016.
EAU Guidelines on Urological Infections and Upper Urinary Tract Obstruction. European Association of Urology (EAU), 2023. Available at: https://uroweb.org/guidelines
Hautmann, R. and Gschwend, J.E. (Eds.): Urologie. 5th Edition. Springer Verlag, Berlin/Heidelberg, 2014.

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