Advancing Ureteral Stricture Treatment with Robotic-Assisted Surgery

By Ahmad El-Arabi, MD, Urology

Ureteral stricture is a narrowing of the ureter, the tube that carries urine from the kidney to the bladder. This can cause significant pain, recurrent infections, and impaired kidney function. Traditional treatments often involve open surgery or repeated endoscopic procedures, which may lead to prolonged recovery and inconsistent results. Loyola Medicine’s robotic-assisted ureteral reconstruction offers a minimally invasive, highly precise solution for strictures caused by radiation therapy, scar tissue, inflammation, trauma, or previous surgeries. This advanced approach improves outcomes by reducing complications, enhancing precision, and promoting faster recovery.

What are ureteral strictures?

Ureteral strictures occur when the ureter — the tube that carries urine from the kidney to the bladder — becomes narrowed or blocked. This obstruction disrupts normal urine flow and can lead to significant complications, including infections and kidney damage. Strictures can develop for various reasons, including:

• Radiation therapy – Fibrosis and scarring from radiation exposure can cause ureteral narrowing over time.
• Scar tissue buildup – Strictures can form after surgery, endoscopic procedures, or prolonged use of ureteral stents.
• Inflammation – Chronic infections or conditions like ureteritis can contribute to stricture formation.
• Trauma or injury – Blunt abdominal trauma, pelvic fractures, or surgical complications may result in ureteral damage.
• Previous surgical complications – Strictures can arise as a postoperative complication of pelvic or abdominal surgeries.

Regardless of the cause, untreated ureteral strictures can progressively worsen, leading to more severe complications that affect kidney function and overall health.

Symptoms of ureteral strictures

The severity of symptoms varies depending on the degree of obstruction, but common signs include:

• Flank (side) or lower abdominal pain – Pain may be persistent or intermittent, depending on the severity of the blockage.
• Recurrent urinary tract infections (UTIs) – Blocked urine flow can create an environment for bacterial growth.
• Hematuria (blood in urine) – May indicate irritation or damage to the ureter.
• Decreased kidney function – Prolonged obstruction can lead to kidney damage and reduced function.
• Hydronephrosis (swelling of the kidney) – A result of urine buildup caused by the blockage.

Because ureteral strictures can lead to chronic kidney disease and long-term complications, early diagnosis and intervention are crucial. Robotic-assisted ureteral reconstruction offers a highly effective, minimally invasive solution to restore normal urine flow, relieve symptoms, and prevent further damage.

Advantages of robotic reconstructive urology

Robotic-assisted ureteral reconstruction has revolutionized the treatment of ureteral strictures, offering a minimally invasive, highly precise surgical option that significantly improves patient outcomes. Unlike traditional open surgery, which requires large incisions and longer recovery times, robotic-assisted techniques allow surgeons to perform delicate reconstructive procedures with enhanced precision, reduced risk, and faster recovery.

Minimally invasive approach

Robotic-assisted surgery provides superior dexterity and visualization compared to traditional techniques. The robotic system enhances the surgeon’s ability to:

• Perform precise dissection and suturing, reducing the risk of damaging healthy tissue.
• Navigate complex anatomy with high-definition, magnified 3D visualization, allowing for meticulous reconstruction.
• Improve surgical accuracy, ensuring better long-term outcomes for patients.

Improved patient outcomes

Robotic-assisted ureteral reconstruction is associated with high success rates and lower complication risks. Patients benefit from:

• Reduced risk of complications such as strictures recurring or infections developing.
• Excellent long-term function, preserving kidney health and preventing further damage.
• Shorter hospital stays, allowing for a quicker transition back to daily life.

This state-of-the-art approach provides an optimal solution for patients with ureteral strictures who require surgical intervention. By offering a more effective, less invasive option, Loyola Medicine ensures patients receive the highest level of care with the best possible outcomes.

Is robotic-assisted ureteral reconstruction right for me?

Robotic-assisted ureteral reconstruction is an advanced surgical option designed for patients experiencing persistent or severe ureteral strictures that impact their quality of life and kidney function. While some mild strictures can be managed with stents or endoscopic treatments, robotic surgery is often the best solution for patients who require definitive, long-term repair.

Candidates for robotic-assisted ureteral reconstruction include:

• Patients with recurrent ureteral strictures – Those who have undergone previous treatments, such as stenting or dilation, but continue to experience obstruction or symptoms
• Patients with symptomatic strictures – Individuals suffering from chronic pain, recurrent urinary tract infections (UTIs), hematuria, or declining kidney function due to a ureteral blockage.
• Patients with strictures caused by radiation therapy – Individuals who have developed fibrotic scarring in the ureter as a result of cancer treatment.
• Patients with traumatic or surgical ureteral injury – Those who have sustained ureteral damage due to pelvic trauma, prior abdominal surgeries, or surgical complications.
• Patients seeking a minimally invasive alternative to open surgery – Those who are not ideal candidates for open reconstruction due to comorbidities or personal preference for a shorter recovery time.

Why choose Loyola Medicine for robotic-assisted ureteral reconstruction?

Specialized expertise in urologic reconstruction

Loyola Medicine is home to fellowship-trained urologic surgeons with extensive experience in robotic-assisted ureteral reconstruction. Our team is skilled in managing both simple and complex ureteral strictures, including those resulting from radiation therapy, previous surgeries, or traumatic injuries.

Advanced robotic technology

Our state-of-the-art robotic surgical system allows for:

• High-definition 3D visualization for unparalleled precision in complex reconstructions.
• Minimally invasive techniques that reduce surgical trauma, pain, and recovery time.
• Enhanced dexterity and control, enabling precise suturing and tissue preservation.

Collaborative, multidisciplinary approach

Our specialists work closely with referring physicians to develop individualized treatment plans for each patient. We ensure thorough preoperative evaluation to determine the most effective treatment strategy, coordinated postoperative follow-up to optimize recovery and monitor long-term success, and streamlined referral process, making it easy for physicians to connect patients with our team.

Ahmad El-Arabi, MD, is a Urologist at Loyola Medicine specializing in abdominal urologic reconstruction urethral reconstruction, urinary incontinence and erectile dysfunction. He was a key figure in advancing the use of robotic minimally invasive surgery in urology reconstruction. Dr. El-Arabi earned his medical degree from the Medical College of Wisconsin and completed his residency at the University of Kansas, School of Medicine (Urology). He completed his fellowship at Loyola University Medical Center.

Book an appointment today to see Dr. Ahmad El-Arabi or another Loyola Medicine Urologist by self-scheduling an in-person or virtual appointment using myLoyola.