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Ureteral Strictures after Radiation

Ureteral Strictures after Radiation

Question

Dear OncoLink "Ask The Experts,"

Is it possible to develop a stricture of the ureter as a result of radiation damage [after prostate cancer treatment]?

Answer

Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:

Ureteral strictures are very rare because the ureter is generally not included in the prostate volume that is treated. However, there are rare cases where this may occur. The problem relates to embryology and human development.

Embryologically, the ureter develops from the kidney, and as the ureter grows, it travels down to the bladder and inserts into it (into an area called the bladder trigone). Thus, the ureters serve as a connection between the kidneys, where urine is made, and the bladder, where urine is stored. This connection of the ureters into the bladder frequently occurs several centimeters from the prostate gland, but in rare cases could be closer to the prostate (or even pass through the prostate). In these cases, the radiation aimed at the prostate could cause a stricture of the ureter(s).

Still, the more common causes of strictures include kidney stones, urinary reflux, and most importantly tumor, since it is relatively common for the seminal vesicles to abut the ureters. So stage T3 prostate tumors (which involve the seminal vesicles) will be the most common cause of ureteral stricture in older men with prostate cancer.