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Endoureterotomy
Endoureterotomy is a minimally invasive procedure in which a urologist uses a small scope to cut open and widen a narrowed section of the ureter, the tube that carries urine from your kidney to your bladder. A temporary stent is left in place while the ureter heals.
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Briefly about this treatment
Indications
A narrowed or scarred segment of the ureter (ureteral stricture), usually short, that blocks urine flow and strains the kidney, especially after earlier surgery, stone treatment or a kidney transplant.
Risks
Blood in the urine, stent discomfort, infection, urine leak, and the stricture coming back. Risks are reduced by careful patient selection and an experienced endourology team.
Pre-procedure
Imaging of the ureter (such as a CT urogram), blood and kidney function tests, a urine culture to rule out infection, an anaesthesia consultation, and fasting per protocol.
Follow-up
A stent check and removal at about 4-6 weeks, imaging to confirm the ureter has stayed open, then periodic scans and kidney function tests, mainly over the first one to two years.
What is Endoureterotomy? An expert explains
When a ureter narrows, from scar tissue after surgery, a stone, an infection, or radiation, urine backs up and puts pressure on the kidney behind it. Endoureterotomy treats that narrowing directly: your urologist passes a thin ureteroscope up through the bladder (a retrograde approach), or, less often, through a small access point in your back into the kidney (an antegrade approach), and guides it to the stricture under X-ray guidance. Using a cold knife, an electrocautery probe, or, most commonly today, a holmium or thulium laser fibre, the surgeon makes a full-thickness cut through the scarred segment, then dilates it with a balloon to the target width. A double-J (JJ) stent is left inside the ureter for several weeks afterwards, holding the channel open while the lining heals around its new, wider shape.
It is a different procedure from balloon dilation alone (which stretches the stricture without cutting it and tends to be less durable) and from open, laparoscopic or robotic ureteral reconstruction (which removes or rebuilds the narrowed segment and is generally more durable for longer or more complex strictures). Endoureterotomy sits between the two: less invasive than reconstruction, more durable than dilation alone, for the right stricture.
Signs it may be time for Endoureterotomy
A narrowed ureter often develops quietly, and the symptoms can be vague or come and go. Things you may notice or feel include:
- Flank or back pain. A dull ache or sharp pain on one side of your back, sometimes spreading to the lower abdomen, is the most common sign. It can get worse after drinking a lot of fluid, because more urine is pushing against the blockage.
- Recurrent urinary tract infections. Urine that can’t drain freely is more likely to become infected, so repeated infections on the same side can point to a blockage.
- Blood in the urine. You may see pink, red or brown urine, or it may only show up on a urine test.
- Fever, nausea or vomiting with flank pain. Together these can signal an infection behind the blockage and need prompt medical attention.
- No symptoms at all. Sometimes a stricture is found on a scan done for another reason, for example when the kidney looks swollen. Silent blockage can still damage the kidney over time, which is why it is worth treating.
The symptoms above are not specific to one problem, so a urologist confirms the cause with imaging. Endoureterotomy is usually considered when the scan shows a short stricture and the kidney behind it still works reasonably well.
Conditions linked to endoureterotomy
These are the conditions most often connected to this treatment. Select a condition to read more about it:
- Urolithiasis: stones anywhere in the urinary tract. A stone that gets stuck in the ureter, or the scope procedures used to remove it, can irritate and scar the ureter wall and lead to a narrowing later on.
- Nephrolithiasis (Kidney Stones): hard mineral deposits that form in the kidney and travel down the ureter. Repeated stone passage or treatment is one of the most common reasons a ureter narrows.
- Ureteropelvic Junction Obstruction: a blockage where the ureter leaves the kidney. It is a closely related problem, and the endoscopic version of the same technique at that spot is called endopyelotomy.
- Hydronephrosis: swelling of the kidney caused by urine building up behind a blockage. It is often how a hidden ureteral narrowing is first spotted on an ultrasound or CT scan.
- Obstructive Uropathy: any blockage of urine flow that affects how well the kidney works. A narrowed ureter is one cause, and opening it is meant to protect kidney function.
When to consult a specialist
If some of these symptoms sound familiar, try not to worry. A narrowed ureter is a well-understood problem, and it is usually found and managed early with simple tests: a urine test, a blood test to check how well your kidneys are working, and an ultrasound or CT scan. Many people have this checked and then get a clear plan. If you have a fever, severe pain, or cannot pass urine, seek urgent care rather than waiting. Otherwise, a urologist can look at your results, explain what is going on and tell you whether endoureterotomy suits you.
How a session works
- Before the procedure. Your urologist confirms your urine is infection-free (or treats any infection first), reviews your imaging to map the stricture’s exact location and length, and goes over the anaesthesia plan with you.
- Access. Most of the time the ureteroscope is passed up through the urethra and bladder into the ureter, a retrograde approach with no external cut at all. If retrograde access is difficult (for example in some transplant ureters or completely blocked strictures), the surgeon may instead go in through a small access point in your back into the kidney, an antegrade approach, sometimes combining both.
- Locating the stricture. A guidewire is passed to the narrowed segment, and contrast dye with X-ray (fluoroscopy) confirms exactly where the stricture is and how long it is.
- The incision. The surgeon makes a full-thickness cut through the scarred segment using a cold knife, a small electrocautery probe, or, most often in current practice, a holmium or thulium laser fibre. The cut is placed on a specific side of the ureter to steer clear of nearby blood vessels.
- Dilation. A balloon catheter is inflated across the incised segment to open it to the target width.
- Stenting. A double-J (JJ) stent is left inside the ureter, running from kidney to bladder, to hold the channel open while it heals. If an antegrade approach was used, a temporary nephrostomy tube (a drain through your back) may also be left in for a short time.
Session duration
30 minutes - 2 hours
recorded for this treatment
Cost verify
$2000–$10000
indicative range
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
For the right stricture, endoureterotomy can relieve a blockage without major surgery. The main advantages are:
- Minimally invasive. The whole procedure is done through a scope, usually with no cut on your abdomen, so there is less pain and less scarring than with open surgery.
- Shorter stay and quicker return to daily life. Most people go home the same day or after one night, and recover faster than after open, laparoscopic or robotic reconstruction.
- Protects your kidney. Opening the blockage lets urine drain freely again, which relieves pressure on the kidney and lowers the risk of repeated infections and long-term damage.
- Keeps other options open. If the stricture comes back, a failed endoureterotomy does not rule out a later reconstruction, which is why it is often tried first.
- Can be repeated. If the narrowing returns, the procedure can often be done again before moving to a larger operation.
Risks & side effects
The treatment has risks and trade-offs to discuss with your care team. The information below comes from this treatment’s data. Blood in the urine, stent discomfort, infection and the stricture returning are the main concerns. Risks are minimised by careful patient selection and experienced endourology teams.
Most people notice some of the following, and they are usually mild and temporary:
- Blood in the urine. Pink or light red urine is common for a few days, especially after activity, and usually settles on its own.
- Stent discomfort. The stent can cause urgency, needing to urinate often, and a mild ache in the side or lower abdomen, particularly after urinating. Your care team can suggest medication to ease this, and it ends when the stent is removed.
- Burning when you urinate. This is a short-lived irritation from the scope and stent.
- Urinary tract infection. Bacteria can reach the urinary tract during or after the procedure, so you are checked beforehand and may be given antibiotics.
- The stricture coming back. The narrowing can return, most often within the first year. This is less likely for short strictures with a good blood supply and a well-working kidney.
Who it may not suit: Longer strictures (over about 2 cm), strictures caused by radiation or poor blood supply, and a kidney that contributes very little to overall kidney function are less likely to respond. An active, untreated urinary infection means the procedure is usually postponed. These are general cautions, not a personal verdict. A qualified clinician must assess your full medical picture before recommending or delaying treatment.
What happens during & after
During: you are under anaesthesia and won’t feel the procedure itself. The X-ray imaging used to guide the instruments is brief and not something you will notice.
Right after: some blood-tinged urine is expected for the first few days, especially with activity. Bladder discomfort, urgency or needing to urinate often is common with the stent in place. This is expected and usually manageable, not a sign anything went wrong. Most people go home the same day or after one night, once they are recovering well from the anaesthetic.
In the following weeks: the stent generally stays in for about 4-6 weeks while the cut segment heals around its new, wider shape. Before or at stent removal, follow-up imaging (a nephrostogram, CT urogram or renal scan) checks that the ureter has stayed open. Because most recurrences show up within the first year, imaging typically continues periodically afterwards, for example around 3 months and then roughly every 6 months for up to two years.
Possible complications
Serious problems are uncommon, but it helps to know what they are and why your team watches for them:
- Urine leak (urinoma). Urine can collect outside the ureter at the incision site. It often resolves on its own, but sometimes needs a drain.
- Ureteral injury or perforation. The ureter wall can be damaged during the procedure, which may need extra stenting or a short drain while it heals.
- Significant bleeding. Bleeding that needs treatment is uncommon, and transfusion is rarely required.
- Injury to a nearby blood vessel. This is rare but the most serious risk of the cutting step, which is why the incision is placed on a specific side of the ureter.
- Kidney infection or sepsis. An infection behind a partly blocked kidney can spread. Fever, chills or worsening side pain after the procedure need urgent attention.
- Treatment not lasting. If the stricture returns, you may need a repeat endoureterotomy or a reconstruction. Rarely, if the kidney’s function is already severely and permanently reduced, removing that kidney is discussed.
Remember:
New or severe symptoms require prompt medical advice. Do not wait for a routine appointment if you feel seriously unwell.
Recovery
Recovery is usually quick, and much of it is about living comfortably with the stent until it is removed.
The first days. Most people go home the same day or after one night. You may notice blood-tinged urine, mild soreness and an urge to urinate more often. Drink plenty of fluids unless told otherwise, take pain relief as directed, and avoid heavy lifting and strenuous activity for as long as your surgeon advises. Many people return to desk-based work within a few days to a week, but ask your surgeon about your own timeline.
Living with the stent (about 4-6 weeks). Urgency, frequency, mild flank discomfort and the odd bit of blood in the urine are normal. Your care team may prescribe medication to ease the bladder symptoms. Keep the stent-removal appointment: a stent left in too long can cause its own problems, such as encrustation and infection.
When to get urgent help. Contact your care team or seek emergency care if you have:
- fever or chills
- severe or worsening flank pain that medication does not control
- no urine at all
- heavy bleeding or large clots
Stent removal and follow-up. The stent is usually removed with a short outpatient cystoscopy. Imaging then confirms the ureter has stayed open, followed by periodic scans and blood and urine tests (such as creatinine) over the first one to two years, since most recurrences appear in the first year.
Clinics offering Endoureterotomy
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
Is endoureterotomy painful?
You are under general or spinal anaesthesia, so you won't feel the procedure. Afterwards, most discomfort comes from the stent rather than the cut, and it can usually be managed with medication from your care team.
How successful is it?
It depends mostly on the stricture. Published series report long-term success of roughly 60-80% for short strictures (under about 2 cm) not caused by radiation, in kidneys that still work reasonably well. Success is lower for longer or radiation-related strictures. Your urologist can give you a realistic estimate for your own scan.
How is it different from balloon dilation or reconstructive surgery?
Balloon dilation stretches the narrowing without cutting it and tends to be less durable. Reconstructive surgery (open, laparoscopic or robotic) removes or rebuilds the narrowed segment and is usually more durable for long or complex strictures, but it is a bigger operation. Endoureterotomy sits in between.
Will I need to stay in hospital?
Usually not for long. Most people go home the same day or after one night, depending on the approach used and your general health.
Is removing the stent painful?
Stent removal is normally a short outpatient cystoscopy, often under local anaesthesia. You may feel pressure or a brief sting, and some mild burning or blood-tinged urine for a day or so afterwards.
What happens if the stricture comes back?
It can happen, most often within the first year, which is why follow-up scans matter. Your urologist may repeat the procedure or recommend a reconstruction. A failed endoureterotomy does not rule out other treatments.
Sources
- Endoureterotomy for Treatment of Ureteral StricturesJournal of Urology (American Urological Association)
- Ureteroscopic endoureterotomyPubMed (U.S. National Library of Medicine)
- Current status of minimally invasive endoscopic management of ureteric stricturesPubMed Central (U.S. National Library of Medicine)
- Ureteral Stricture Treatment & ManagementMedscape
- The Current Role of Endourologic Management of Renal Transplantation ComplicationsPubMed Central (U.S. National Library of Medicine)
- Percutaneous ureteral incision for ureteroenteroanastomotic stricture using the holmium laserPubMed Central (U.S. National Library of Medicine)
- Ureteroscopic laser endopyelotomy: a single-center experienceMD Anderson Cancer Center research portal
- The "Cut-to-the-Light" Technique Laser Endoureterotomy for Complete Ureteral ObstructionResearch and Reports in Urology (via DOAJ)