Diseases of ureters

1. Lesions of the ureters

2. Intraluminal lesions
• Ureteric calculi
– 90% of radiooopaque filling defects and vast majority of the radiolucent
filling defects.
• Clots
– SloughSloughed papilla in papillary necrosis
– Sloughed off fragments in necrozing tumors
• Inflammatory masses – debris, pus, organisms (may be fungal in
origin – candida, aspergillus)
• Air bubbles
– Ureteric diversion, instrumentation, gastric or cutaneous fistulas, infection
with gas producing organisms
• Polypoidal tumors - intraluminal filling defects
• Other diseases with exophytic pattern – may appear as filling
defects => eg edema, post instrumentation, malakoplakia,
leukoplakia, pyeloureteritis cystica, extrinsic vessels

3. Mural lesions
• Tumors:
– TCC (90%) and SCC (5-10%), others rare: adenoCa, Sarcoma
– One-third of TCC are infiltrative and produce stricture
• Oedema- recent passage of calculus and instrumentation
• Leukoplakia
• Pyeloureteritis cystica
• Intramural HHG
• TB
• Schistosomiasis
• Endometriasis
• Ureteric narrowing – post radiation (1 yr after RT), direct
trauma

4. Extrinsic lesions
• Hypertrophied ureteric and retroperitoneal arteries
– Hypervascular tumor, RAS, AVM and occlusive aortoiliac disease
– Enlarged gonadal veins – varices (male or female), Ovarian vein syndrome,
gonadal thrombophlebitis and iliac vein occlusion
• Aneurysm
– Aortic aneurysm
– Common iliac artery aneurysm
• Tumors
– Gynecological, anorectal, lower urinary tract
– Lymph nodes
• Retroperitoneal fibrosis
• Benign causes:
– Physiological hypertrophy of Psoas – displace ureters medially
– Pelvic lipomatosis – pear shaped bladder

5. Retroperitoneal fibrosis
• Fibrosis and chronic inflammatory cell infiltrate of retroperitoneal tissues
• 50% idiopathic
• Other causes: secondary to inflammatory aortic aneurysms, vascular
grafts, retroperitoneal masses, retroperitoneal HHG, abscess, urinoma,
diverticulitis, appendicitis, Crohn disease, drugs (Ergots)
• Associated with inflammatory bowel disease, sclerosing cholangitis and
fibrosing mediastinitis
• Features:
– Starts lateral to the aorta so left ureter is involved first
– Location: M/C L3-L5
– Encases ureters, loss of peristalsis without ureteric invasion
• IVU: medial deviation of ureters
• CT and MRI:
– smooth sheets of tissues around and over aorta and IVC
– Vs Lymphoma: floating aorta sign
• Treatment: surgical lateral displacement of ureters