Ureteric Stricture Treatment in Singapore
Comprehensive ureteric stricture treatment by MOH-accredited urologists in Singapore. Learn about causes, surgical options, and recovery process.
Dr. Lie Kwok Ying
BA MBBChir (Cantab)|MRCS (Edin)|FRCS (Urol)(Glasg)|FAMS
Introduction
Living with a ureteric stricture can significantly impact your quality of life, causing discomfort, kidney problems, and recurring infections. This narrowing of the ureter—the tube connecting your kidney to your bladder—requires timely medical attention to prevent serious complications. In Singapore, MOH-accredited urologists offer various treatment approaches to restore proper urine flow and preserve kidney function. Understanding your treatment options helps you make informed decisions about managing this condition effectively.
What is Ureteric Stricture Treatment?
Ureteric stricture treatment encompasses various medical and surgical interventions designed to widen or bypass narrowed sections of the ureter. The ureter is a crucial part of your urinary system, carrying urine from the kidneys to the bladder. When scar tissue or other abnormalities cause narrowing (stricture), urine flow becomes obstructed, potentially leading to kidney damage.
Treatment aims to restore normal urine drainage, relieve symptoms, and preserve kidney function. The approach depends on the stricture’s location, length, and cause. Options range from minimally invasive endoscopic procedures to reconstructive surgery. Modern techniques allow urologists to treat even complex strictures successfully, often using minimally invasive methods that reduce recovery time and complications.
Success rates vary based on stricture characteristics and chosen treatment method. Short strictures typically respond well to endoscopic management, while longer or recurrent strictures may require surgical reconstruction. Your urologist will recommend the most appropriate approach based on comprehensive evaluation of your specific condition.
Who is a Suitable Candidate?
Ideal Candidates
- Patients with confirmed ureteric stricture on imaging studies
- Those experiencing symptoms like flank pain, recurrent UTIs, or kidney dysfunction
- Individuals with hydronephrosis (kidney swelling) due to obstruction
- Patients who have failed conservative management
- Those with adequate kidney function in the affected side
- Individuals healthy enough to undergo the recommended procedure
- Patients committed to follow-up care and monitoring
Contraindications
- Severe kidney damage with non-functioning kidney (may require nephrectomy instead)
- Active untreated urinary tract infection
- Severe bleeding disorders that increase surgical risks
- Certain medical conditions that make anaesthesia unsafe
- Pregnancy (for some treatment options)
- Inability to maintain required post-procedure positioning
A thorough evaluation by your urologist determines the most suitable treatment approach. This assessment includes imaging studies, kidney function tests, and overall health evaluation. Some patients may need preliminary treatments, such as nephrostomy tube placement, before definitive stricture treatment.
Treatment Techniques & Approaches
Endoscopic Management
Endoscopic treatment involves accessing the stricture through natural urinary passages using specialised instruments. This minimally invasive approach includes balloon dilation, where a small balloon is inflated within the stricture to widen it, or endoureterotomy, where the stricture is incised using laser or cold knife. These procedures are typically performed under general anaesthesia and offer quick recovery times.
Ureteral Stenting
Ureteral stents are thin tubes placed within the ureter to maintain patency. Double-J stents, named for their curled ends, are commonly used for temporary relief or as adjuncts to other treatments. While stenting alone rarely provides permanent cure, it plays a crucial role in emergency management and post-operative care. Long-term stenting may be necessary for patients unsuitable for definitive surgery.
Surgical Reconstruction
For longer strictures or when endoscopic treatment fails, surgical reconstruction offers definitive treatment. Procedures include ureteroureterostomy (end-to-end repair), ureteral reimplantation into the bladder, or ileal ureter substitution using a segment of intestine. The choice depends on stricture location and length. These procedures require more extensive recovery but offer good long-term success rates.
Technology & Equipment Used
Modern ureteric stricture treatment utilises various technologies including flexible and rigid ureteroscopes, holmium laser systems for precise incision, fluoroscopic guidance for accurate positioning, and robotic-assisted surgical systems for complex reconstructions. These tools enable precise treatment while minimising tissue trauma.
The Treatment Process
Pre-Treatment Preparation
Before your procedure, you’ll undergo comprehensive evaluation including CT urogram or retrograde pyelography to assess stricture characteristics. Blood tests evaluate kidney function and overall health. You may need to stop certain medications, particularly blood thinners, before surgery. Antibiotics are often prescribed to prevent infection. Fasting instructions vary based on the planned procedure and anaesthesia type.
During the Procedure
For endoscopic procedures, you’ll receive general or spinal anaesthesia. The urologist inserts a ureteroscope through the urethra and bladder to reach the stricture. Using specialised instruments or laser, the stricture is dilated or incised. A ureteral stent is typically placed to maintain patency during healing. The procedure usually takes 30-90 minutes.
Surgical reconstruction requires general anaesthesia and may take 2-4 hours. The surgeon accesses the ureter through an abdominal incision (open surgery) or multiple small incisions (laparoscopic/robotic approach). After removing the strictured segment, the ureter is repaired or reconstructed. Drains may be placed to monitor for leaks.
Immediate Post-Treatment
Following endoscopic procedures, you’ll recover in the post-anaesthesia care unit for 1-2 hours. Most patients go home the same day or after an overnight stay. You may experience mild discomfort, blood in urine, or urgency due to the stent. Pain medication and antibiotics are prescribed.
After surgical reconstruction, hospital stay typically ranges from 2-5 days. You’ll have a urinary catheter and possibly surgical drains. Pain management includes oral or intravenous medications. Early mobilisation helps prevent complications. Discharge occurs once you’re comfortable, eating normally, and drains show no leakage.
Recovery & Aftercare
First 24-48 Hours
Rest is essential during initial recovery. Maintain adequate hydration to flush the urinary system. You may notice blood-tinged urine, which is normal. Take prescribed medications as directed, including antibiotics and pain relievers. Avoid strenuous activities, heavy lifting, or straining. Monitor for signs of infection such as fever, severe pain, or cloudy urine. Contact your urologist if concerning symptoms develop.
First Week
Continue limiting physical activities while gradually increasing daily movements. Maintain good hydration with 2-3 litres of water daily unless restricted. Attend your follow-up appointment for wound check (if applicable) and to ensure proper stent position. You may experience stent-related symptoms like urgency, frequency, or mild flank discomfort with urination. These symptoms are temporary and resolve after stent removal.
Long-term Recovery
Complete healing takes 4-6 weeks for endoscopic procedures and 6-8 weeks for surgical reconstruction. Stent removal typically occurs 4-6 weeks post-procedure. Return to normal activities is gradual—light work after 1-2 weeks, full activities after 4-6 weeks. Regular follow-up includes imaging studies to ensure maintained ureteral patency. Long-term monitoring continues for several years to detect recurrence early.
Get an Accurate Diagnosis & Proper Treatment for Your Urinary Symptoms / Conditions
Benefits of Ureteric Stricture Treatment
Successful treatment provides significant improvements in quality of life and kidney health. Primary benefits include restoration of normal urine flow from kidney to bladder, eliminating the obstruction that causes pain and kidney damage. This prevents or reverses hydronephrosis, preserving kidney function.
Patients experience relief from recurrent urinary tract infections that often accompany strictures. The chronic flank pain associated with obstruction resolves, allowing return to normal activities. Treatment prevents progressive kidney damage that could lead to kidney failure requiring dialysis.
Many patients report improved overall well-being after successful treatment. The anxiety associated with recurrent infections and hospital visits diminishes. Normal urinary function restoration means freedom from temporary drainage tubes or frequent medical interventions. For younger patients, preserving kidney function ensures long-term health and prevents future complications.
Risks & Potential Complications
Common Side Effects
Temporary blood in urine (haematuria) occurs in most patients, typically resolving within days. Stent-related discomfort affects many patients, causing urgency, frequency, or mild pain with urination. These symptoms persist until stent removal. Mild pain at surgical sites is managed with oral pain medication. Temporary bladder spasms may occur, particularly with stent movement.
Rare Complications
Stricture recurrence remains the primary long-term concern, occurring in 10-30% of cases depending on initial stricture characteristics and treatment method. Ureteral injury during treatment is rare but may require additional intervention. Infection, though uncommon with proper antibiotic prophylaxis, requires prompt treatment. Rarely, urine leakage from surgical sites necessitates prolonged drainage.
Our experienced urologists minimise risks through careful patient selection, meticulous surgical technique, and comprehensive post-operative care. Regular follow-up allows early detection and management of any complications.
Cost Considerations
Treatment costs vary significantly based on the chosen approach and stricture complexity. Factors influencing cost include the type of procedure (endoscopic versus surgical reconstruction), hospital stay duration, and need for specialised equipment or materials. Additional considerations include pre-operative investigations, anaesthesia fees, and post-operative care requirements.
Costs typically encompass surgeon fees, hospital charges, anaesthesia services, medications, and follow-up care. Complex reconstructive procedures requiring longer operating time and hospital stays naturally incur higher costs. Some patients require multiple procedures or long-term stenting, affecting overall treatment expenses.
Quality care from experienced urologists often results in better outcomes and fewer repeat procedures. During consultation, your urologist will discuss expected costs based on your specific treatment plan.
ask us anything
Frequently Asked Questions
How long does ureteric stricture treatment take to perform?
Endoscopic procedures typically take 30-90 minutes, while surgical reconstruction may require 2-4 hours. The exact duration depends on stricture location, length, and complexity. Your urologist will provide a more accurate estimate based on your specific condition during pre-operative planning.
Will I need a stent after treatment, and for how long?
Most patients require temporary stenting after stricture treatment to ensure healing and maintain ureteral patency. Stents typically remain for 4-6 weeks but may be needed longer for complex cases. Your urologist determines the optimal duration based on your stricture characteristics and healing progress.
What is the success rate of ureteric stricture treatment?
Success rates vary by treatment type and stricture characteristics. Endoscopic management succeeds in 50-70% of cases for short strictures, while surgical reconstruction achieves success rates exceeding 90% for appropriate candidates. Factors affecting success include stricture length, location, and cause.
Can ureteric strictures recur after treatment?
Recurrence is possible, occurring in 10-30% of cases depending on initial treatment and stricture type. Regular monitoring helps detect recurrence early when it’s most treatable. Risk factors for recurrence include long strictures, ischaemic strictures, and previous radiation therapy.
How soon can I return to work after treatment?
Return to work depends on your procedure type and job requirements. After endoscopic treatment, desk work is possible within 3-5 days, while physical jobs require 2-3 weeks. Surgical reconstruction patients typically need 2-3 weeks for desk work and 4-6 weeks for physical labour.
What follow-up care is required after treatment?
Follow-up includes stent removal at 4-6 weeks, imaging studies at 3 months to confirm patency, and regular monitoring for 2-3 years to detect recurrence. The exact schedule depends on your stricture type and treatment performed. Long-term surveillance ensures maintained kidney function.
Are there alternatives to surgery for ureteric strictures?
While definitive treatment usually requires intervention, temporary measures include ureteral stenting or nephrostomy tube placement. These provide drainage but don’t cure the stricture. Some patients unsuitable for definitive treatment may require long-term stenting with regular changes.
Conclusion
Ureteric stricture treatment offers effective solutions for restoring normal urinary function and preserving kidney health. With various treatment options available, from minimally invasive endoscopic procedures to definitive surgical reconstruction, patients can achieve positive outcomes when treated by experienced urologists. The key to successful treatment lies in accurate diagnosis, appropriate procedure selection, and comprehensive follow-up care. Modern techniques and technology have significantly improved success rates while reducing recovery times and complications.
Dr. Lie Kwok Ying
BA MB BChir (Cantab)|MRCS (Edin)|MMEd (Surg)|FRCS (Glasg)(Urol)|FAMS
Dr. Lie Kwok Ying is a Senior Consultant Urologist and pioneered the use of HoLEP (Holmium Enucleation of Prostate) for benign prostatic hyperplasia (BPH) in Singapore.
He graduated from Queens’ College in Cambridge University with triple First Class Honours and subsequently qualified in 2001 with degrees in Medicine and Surgery.
Clinical Interests in Urology
Make an Enquiry
For urgent or same day appointment requests, please call our hotline.
Our Urology Clinic Locations in Singapore
Gleneagles Medical Centre
6 Napier Road, #04-07, Singapore 258499
+65 6475 3668 (tel)
Monday-Friday: 08:30am – 5:00pm
Saturday: 08:30 am – 12:00 pm
Sunday / PH: CLOSED
MT Alvernia Medical Centre A
820 Thomson Road, #02-01, Singapore 574623
+65 6553 5066 (tel)
Monday-Friday: 08:30am – 5:00pm
Saturday: 08:30 am – 12:00 pm
Sunday / PH: CLOSED