Recurrent stricture following ureteropelvic junction obstruction (UPJO) repair remains a challenging clinical problem. Scar formation at the surgical anastomosis can lead to recurrent narrowing, while repeat reconstructive surgery may involve greater surgical trauma and technical complexity. In this case, a patient with recurrent upper ureteral stricture following previous UPJO repair was treated using a retrograde approach with balloon dilation and covered ureteral stent placement. At the 1-month follow-up, the stent remained in position without migration, and the ureter was patent.

Case Presentation

A 61-year-old male was admitted with left flank and abdominal pain, chills, and rigors, occurring 4 months after left ureteral stent placement.

Three days prior to admission, the patient developed recurrent dull pain in the left flank and abdomen without an apparent trigger. The pain radiated to the left lower abdomen and was accompanied by nausea and vomiting when severe. The patient had previously undergone UPJO repair for left hydronephrosis and had a ureteral stent in place for an extended period following surgery.

CT imaging showed mild dilation of the left ureter with urinary stasis, as well as small calculi in both kidneys. Preoperative antegrade urography was performed to further define the location and extent of the stricture.

Preoperative diagnosis: Left upper ureteral stricture.

                                          Preoperative Imaging

Antegrade urography demonstrating the location and extent of the left ureteral stricture.

Treatment Strategy

Following a comprehensive clinical assessment, Professor Ji Chundong and his team developed a treatment plan consisting of:

Left ureteral balloon dilation + covered metal stent placement

Given the significant scar formation and adhesions following the previous reconstructive surgery, as well as recurrent obstruction despite long-term stenting, the team selected a minimally invasive endourological approach to avoid the additional trauma associated with repeat reconstructive surgery.

Based on intraoperative measurement of the stricture length, a 195-mm covered mental stent was selected. Compared with a conventional 120-mm stent, the longer stent provided more extensive coverage of the stenotic segment, helping to maintain adequate support and reduce the risk of migration.

The nitinol stent framework provides continuous radial support to the stenotic segment, while the hydrophobic covering covers the stent mesh and is designed to reduce tissue ingrowth and encrustation.

Procedure and Outcome

The patient was placed in the lithotomy position. Retrograde pyelography was performed under C-arm fluoroscopy to visualize the ureteral stricture. The stenotic segment was identified and its length was measured.

                                       Retrograde pyelography

                                      Intraoperative Procedure

The stenotic segment was first dilated using a balloon catheter. The covered ureteral stent was then advanced over a guidewire and positioned across the stricture. Under fluoroscopic guidance, the stent was gradually deployed and fully expanded. After removal of the delivery system, contrast imaging confirmed unobstructed ureteral drainage. Endoscopic examination also confirmed satisfactory stent positioning.

                                   Satisfactory Stent Positioning

     Endoscopic Confirmation of Stent Positioning

Postoperative CT urography (CTU) showed the stent in an appropriate position with satisfactory ureteral patency.

                                           Postoperative CT Urography

Follow-Up

At the 1-month follow-up, CT imaging showed that the stent remained in its intended position without migration. The ureter remained patent, and hydronephrosis had improved compared with the preoperative findings.

                  CT at 1-Month Follow-Up

Covered Ureteral Metal Stent for the Treatment of Ureteral Obstruction Caused by Benign Strictures or Malignant Tumor Compression.