This document discusses lesions of the ureters categorized into intraluminal, mural, and extrinsic lesions. Intraluminal lesions include ureteric calculi, clots, inflammatory masses, air bubbles, and polypoidal tumors. Mural lesions include tumors like transitional cell carcinoma and squamous cell carcinoma, as well as edema, leukoplakia, and pyeloureteritis cystica. Extrinsic lesions compressing the ureters come from enlarged arteries, aneurysms, tumors, retroperitoneal fibrosis, and enlarged veins. Retroperitoneal fibrosis involves inflammatory fibrosis surrounding the ureters and aorta.

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