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Balloon dilation of ureteral stricture
Balloon dilation of a ureteral stricture is a minimally invasive procedure that uses an inflatable balloon catheter to widen a narrowed section of the ureter. It restores urine flow from the kidney to the bladder and helps protect the kidney, usually without any incision.
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Briefly about this treatment
Indications
A benign (non-cancerous) narrowing of the ureter that blocks urine flow, causing flank pain, a swollen kidney (hydronephrosis), repeated urinary infections, or falling kidney function. It works best for short, first-time strictures.
Risks
Stent-related urinary symptoms, infection, bleeding, a small tear in the ureter, and the stricture coming back. Risks are minimised by careful patient selection and an experienced endourology team.
Pre-procedure
Kidney imaging (ultrasound or CT urogram), blood tests for kidney function, a urine culture to rule out infection, anaesthesia consultation, a review of blood thinners, and fasting per protocol.
Follow-up
Stent removal after about 4–6 weeks, then ultrasound or CT and kidney-function checks at set intervals (often around 3, 6 and 12 months) to confirm the ureter stays open.
What is Balloon dilation of ureteral stricture? An expert explains
In plain terms: think of the ureter as a hose that has developed a kinked, scarred section. Balloon dilation doesn’t remove the scar tissue — it stretches it, in the same way a doctor might stretch a tight joint. That’s why it is gentler and faster than reconstructive surgery, but also why it doesn’t work permanently for everyone: scar tissue has a tendency to spring back, which is the main reason strictures can recur after treatment. Urologists usually offer it as the first attempt for short, straightforward strictures, and reserve more invasive options (laser incision, or open/robotic reconstruction) for strictures that don’t respond.
Signs it may be time for Balloon dilation of ureteral stricture
Symptoms you may notice
A narrowed ureter often builds up slowly, so some people feel very little at first. When symptoms do appear, they usually come from urine backing up toward the kidney or from infection above the narrowing. You may notice:
- A dull ache or sharp pain in your side or back (flank pain), sometimes spreading toward the groin — this may get worse when you drink a lot of fluid
- Blood in the urine, which can look pink, red or tea-coloured
- Repeated urinary tract infections, with burning when you pass urine, cloudy or strong-smelling urine, or fever and chills
- Nausea or vomiting together with side pain
- No symptoms at all, with the narrowing found only on a scan or a blood test that shows reduced kidney function
None of these signs proves you have a stricture — many other, more common problems cause the same symptoms — but together with a scan showing a swollen kidney they are the usual reason a urologist suggests this procedure.
Conditions linked to balloon dilation of a ureteral stricture
These kidney and urinary-tract conditions are the ones most often connected with a ureteral stricture and its treatment:
- Obstructive Nephropathy — kidney damage caused by blocked urine flow, which is exactly what opening a stricture aims to relieve
- Hydronephrosis — swelling of the kidney as urine backs up behind the narrowing, and the most common scan finding that leads to this procedure
- Obstructive Uropathy — the wider term for any blockage in the urinary tract that can affect kidney function
- Ureteropelvic Junction Obstruction — narrowing where the ureter leaves the kidney, one of the commonest sites of stricture
- Urolithiasis — stones in the urinary tract; a stone stuck in the ureter, or the procedures used to remove it, can leave scar tissue that narrows the ureter
When to consult a specialist
If some of these symptoms sound familiar, there’s no need to worry — they have many common and treatable causes, and a simple check is usually enough to find out what’s going on. A routine blood test (creatinine and eGFR) and a kidney ultrasound can show whether your kidneys are draining normally, and ureteral strictures that are found early are often treated with a short, minimally invasive procedure. The one situation to act on quickly is side pain together with fever or chills, or being unable to pass urine — in that case, seek urgent medical care. Otherwise, you can take this at your own pace: when you’re ready, a urologist can review your results and explain your options.
How a session works
- Imaging and planning. Before your appointment, your urologist maps the stricture — usually with a CT urogram, ultrasound, or a retrograde pyelogram (a dye study done through a scope) — to see exactly where it is, how long it is, and how the kidney above it looks.
- Anesthesia. Once you’re settled in the operating or procedure room, you’re given general or spinal anesthesia (or, for simpler cases, local anesthesia with sedation).
- Reaching the stricture. Most sessions go retrograde: a thin scope (cystoscope, then ureteroscope) is passed through the urethra into the bladder and up into the ureter, and one or two soft guidewires are threaded across the narrowed segment under direct vision and/or X-ray (fluoroscopy). In more difficult or higher, harder-to-reach strictures — or after a failed retrograde attempt — your urologist may instead go antegrade: a small needle puncture in the back gives direct percutaneous access down into the kidney and ureter.
- Dilating the stricture. A deflated balloon catheter is guided over the wire and centered across the narrowed segment, then inflated with a contrast-mixed fluid to a set pressure — commonly in the range of roughly 8–25 atmospheres depending on the device and how tough the scar tissue is — and held for several minutes so the stretch „sets.”
- Confirming the result. Contrast dye is injected and imaged again (ureteropyelography) to check the segment is adequately open.
- Placing a stent. One or more soft double-J stents are left in the ureter — running from the kidney down to the bladder — to keep it open and draining while the tissue heals.
- Finishing up. The scope is removed, and you’re moved to a recovery area.
Session duration
30–60 minutes
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Cost verify
$1000–$10000
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Anesthesia
General
recorded for this treatment
Remember: The exact steps, duration and preparation can vary with your indication, health and care setting. Confirm the current plan with your treating team.
Benefits
The main appeal of balloon dilation is that it opens the ureter without cutting through the skin, so most people avoid the longer recovery of reconstructive surgery. It is also a flexible first step: if it doesn’t hold, other options remain available.
- No incision: the balloon reaches the narrowing through the bladder (or a small puncture in the back), so there are no large wounds to heal.
- Day-case treatment: most people go home the same day or the next morning.
- Quicker recovery: many people return to light activity within a few days, compared with weeks after open or robotic reconstruction.
- Kidney protection: relieving the blockage lets urine drain again, which can ease pain, lower the risk of infection, and help preserve kidney function.
- Repeatable and stepwise: if the stricture returns, the procedure can be repeated or stepped up to laser incision or reconstructive surgery.
- Best results in the right case: short strictures (under about 2 cm) and first-time strictures respond best.
Risks & side effects
Balloon dilation of a ureteral stricture has risks and trade-offs to discuss with your care team. The information below comes from this treatment’s data and published studies.
Stent-related urinary symptoms, infection, bleeding, a small tear in the ureter, and recurrence of the stricture. Risks are minimised by careful patient selection and experienced endourology teams.
Most of what people feel afterwards comes from the temporary stent rather than the dilation itself:
- Urinary urgency and frequency: the stent’s lower end irritates the bladder, so you may need the toilet more often. In one study of 200 stented patients, about 65% reported urgency and 63.5% frequency.
- Burning or discomfort when passing urine: reported by about 72.5% in the same study, and it usually eases once the stent is out.
- Blood in the urine: pink or reddish urine was reported by about 55.5%; drinking plenty of fluid helps.
- Side or lower-abdominal ache: a mild, on-and-off ache is common, especially after urinating or being active.
- Infection or fever: bacteria can enter the urinary tract during any scope procedure, which is why a urine test comes first and antibiotics may be given.
- Small tear (perforation) of the ureter: reported in around 5% of cases in one large series of ureteral balloon dilation, usually managed on the spot with a stent.
- Anesthesia-related effects: drowsiness, nausea, or a sore throat after general anesthesia, which pass quickly.
Who it may not suit: These are general cautions, not a personal verdict. A qualified clinician must assess your full medical picture before recommending or delaying treatment. Balloon dilation may be less suitable, or may need to wait, if you have an active untreated urinary infection, a very long or completely blocked stricture the guidewire cannot cross, narrowing caused by a tumor pressing on the ureter, or bleeding problems or blood thinners that can’t be safely paused.
What happens during & after
During. Under anesthesia you won’t feel or remember the stretching of the ureter. The team monitors your heart rate, blood pressure and oxygen levels throughout, and the X-ray images taken during the session let them check the ureter is open before the stent goes in. There are no stitches or wounds to look after, because the balloon travels through your natural urinary passages (or, rarely, a tiny puncture in the back).
Immediately after. You wake up in a recovery area where nurses check your blood pressure, heart rate and pain at regular intervals. You may feel sleepy or slightly nauseated for a short while. Because a stent is almost always left in place, you may feel an urge to urinate soon after waking and notice pink-tinged urine — both are expected. Most people are discharged the same day or the next morning once they are alert, drinking, and able to pass urine, with written instructions, a date for stent removal, and a number to call if something feels wrong.
Possible complications
Serious complications are uncommon, and most can be handled when they are caught early. The most important one to know about is that the stricture can narrow again, so follow-up matters even when you feel well.
- Recurrence of the stricture: scar tissue can tighten again after the stent is removed. In one series of 213 patients, success (no further procedure needed) was about 77% one month after stent removal and about 56% at twelve months. Strictures that are short and first-time do better.
- Silent loss of kidney function: if a recurrence goes unnoticed, the kidney can slowly become blocked again without obvious symptoms — one reason for scheduled scans and blood tests.
- Ureteral perforation: a tear that is usually treated by leaving a stent longer, and only rarely needs a drainage tube through the back or surgery.
- Serious infection (urosepsis): a kidney infection behind a blocked ureter can spread to the bloodstream; fever with chills and side pain needs urgent care.
- Stent problems: a stent can move, become coated with mineral crusts (encrustation), or be forgotten — which is why your stent removal date must be kept.
- Needing a bigger procedure: if dilation doesn’t hold, the usual next steps are laser incision (endoureterotomy) or reconstructive surgery such as ureteral reimplantation.
Remember:
New or severe symptoms require prompt medical advice. Do not wait for a routine appointment if you feel seriously unwell.
Recovery
Recovery after balloon dilation is mostly about living comfortably with the stent until it is removed and then making sure the ureter stays open.
First days
Expect mild soreness in the side or lower abdomen, a frequent urge to urinate, and pink-tinged urine. Drink plenty of water unless your doctor tells you otherwise, take any prescribed antibiotics or pain relief as directed, and avoid heavy lifting and strenuous exercise until your urologist clears you. Most people return to desk work and light activity within a few days.
While the stent is in
Stent symptoms — urgency, frequency, mild burning, occasional blood in the urine and a side ache after urinating — usually ease after the first one to two weeks and disappear after removal. If your stent has a thread attached, don’t pull on it unless you’ve been told to. (EAU Patient Information; Kidney Stone Clinic)
Stent removal and follow-up
- Stent removal: usually in clinic with a quick cystoscopy, typically after about 4–6 weeks (ranging from about 1 to 6 months for complex strictures). Most people are awake, with numbing gel.
- Follow-up scans and blood tests: ultrasound or CT, plus kidney-function tests, at intervals your urologist sets — often around 3, 6 and 12 months — because a stricture can return without causing pain.
Call your doctor straight away if you have
- Fever or chills
- Severe pain that medication doesn’t control
- Inability to pass urine
- Heavy bleeding or large clots in the urine
- A sudden, constant leak of urine
Clinics offering Balloon dilation of ureteral stricture
Verified kidney centres linked to this treatment in the KidneyGlobal directory.
Academic Medical Center
Minimally Invasive Urologic Surgery
Joint CommissionNCI Cancer CenterRobotic Surgery Excellence
✓ 24/7 ER✓ ICU✓ Insurance
Specialty Hospital
Comprehensive Kidney & Urologic Care
Joint CommissionU.S. News Best HospitalCenter of Excellence
✓ 24/7 ER✓ ICU✓ Insurance
Johns Hopkins Brady Urological Institute
✓ AccreditedAcademic Medical Center
Urologic Oncology & Innovation
Joint CommissionNCI Comprehensive Cancer CenterResearch Excellence
✓ 24/7 ER✓ ICU✓ Insurance
Good questions
Most Common Questions
Does balloon dilation hurt?
You won't feel the procedure itself because you're under anesthesia. Afterwards, most discomfort comes from the stent — a mild ache and an urge to urinate — and it is usually manageable with simple pain relief approved by your care team.
Can I work and travel while the stent is in?
Most people return to light or desk work within a few days. Avoid heavy lifting and intense exercise, and keep your stent removal date in mind when planning trips, since you'll need to be near your urologist at that time.
How is balloon dilation different from laser incision (endoureterotomy)?
Balloon dilation stretches the narrowed segment, while endoureterotomy cuts through the scar with a laser or blade. Incision tends to have somewhat higher reported success but is a more invasive step, so many urologists try dilation first for short, straightforward strictures.
Will the stricture come back?
It can. Published success rates range widely, and results depend on the stricture's length, location and cause. That's why follow-up scans after the stent is out are an important part of treatment.
Which doctor performs this procedure?
A urologist, often one with extra training in endourology or reconstructive urology. A nephrologist may stay involved if your kidney function is affected.
Will my insurance cover it?
Coverage varies by country and plan. The procedure is generally treated as medically necessary when a stricture blocks the kidney, but ask your clinic for a written cost estimate and whether pre-authorization is needed.
Sources
- Ureteral Stricture Treatment & ManagementMedscape (eMedicine)
- A nomogram to predict stricture-free survival in patients with ureteral stricture after balloon dilationBMC Urology (BioMed Central / Springer Nature)
- Preliminary Outcomes of Different Tactics of Ureteral Stent Placement in Patients with Ureteral Stricture Undergoing Balloon DilatationPubMed Central (US National Library of Medicine)
- Management of Ureteral Stricture Disease After Radiation Therapy for Pelvic MalignanciesPubMed Central (US National Library of Medicine)
- Balloon Dilation of the Ureter: A Contemporary Review of Outcomes and ComplicationsThe Journal of Urology (American Urological Association)
- Symptoms and discomforts associated with double J ureteral stentsBMC Urology (BioMed Central / Springer Nature)
- Double J-stent placementEAU Patient Information (European Association of Urology)
- Ureteral Stricture (Obstruction)UCSF Department of Urology
- Ureteric Stent Information: Double J StentKidney Stone Clinic (Australia)
- CPT 50706: Balloon dilation, ureteral strictureAAPC
- Insurer-negotiated rates for HCPCS 50706Tynbil
- SG704U: Ureter, Stricture, Percutaneous Antegrade Balloon Dilatation (fee benchmarks)Ministry of Health, Singapore
- How Much Does Ureteroscopy Cost?CareRoute