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Ureteric Stricture Disease
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====Benign==== *'''<span style="color:#0000ff">SIIRRII PUF (8):</span>''' #'''<span style="color:#0000ff">S</span><span style="color:#ff0000">tones</span>''' #'''<span style="color:#0000ff">I</span><span style="color:#ff0000">nstrumentation, endoscopic</span>''' #'''<span style="color:#0000ff">I</span><span style="color:#ff0000">nfection (tuberculosis)</span>''' #'''<span style="color:#0000ff">R</span><span style="color:#ff0000">enal ablation injury</span>''' #'''<span style="color:#0000ff">R</span><span style="color:#ff0000">adiation</span>''' #'''<span style="color:#0000ff">I</span><span style="color:#ff0000">schemia</span>''' (trauma, surgical dissection) #'''<span style="color:#0000ff">I</span><span style="color:#ff0000">diopathic</span>''' #'''<span style="color:#0000ff">P</span><span style="color:#ff0000">eri</span><span style="color:#0000ff">U<span style="color:#ff0000">reteral </span><span style="color:#0000ff">F<span style="color:#ff0000">ibrosis caused by abdominal aortic aneurysm or endometriosis</span>''' #*Endometeriosis #**Diagnosis and Evaluation #***History and Physical Exam #****History #*****Signs and Symptoms #******May occur cyclically and include #*******Flank pain #*******Dysuria #*******Urgency #*******Hematuria #*******Frequent urinary tract infections #******Most patients with ureteral obstruction associated with endometriosis are asymptomatic #**Management #***A trial of hormonal therapy using gonadotropin-releasing hormone agonists (Lupron) or medroxyprogesterone (Danazol) should be initiated for mild symptomatic obstruction when there is good preservation of renal function. #***For more severe obstruction associated with significant periureteral fibrosis, surgical intervention to correct the obstruction, with or without hysterectomy and bilateral salpingo-oophorectomy, is recommended *'''Hysterectomy accounts for over 50% of iatrogenic ureteral injuries''' **Most likely areas where the ureter can be occluded during hysterectomy (2): **#Level of the broad ligaments **#At the vaginal cuff and bladder trigone
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