What do you recommend for a woman with a long ureteral stricture after pelvic radiation, currently managed with a stent and good split function but with multiple symptomatic UTIs in the past year?

I routinely offer these women a definitive reconstruction and opportunity to become stent-free. I will usually convert to a nephrostomy tube and assess stricture after a period of ureteral rest. Then counsel on options depending on location.

If she is not interested in definitive reconstruction, and...

With a good split function and three symptomatic UTIs in a year on a chronic stent, I would offer reconstruction if she is a reasonable operative candidate. The stent is the likely source of the infections.

Before surgery: antegrade and retrograde pyelograms to define length and location, a renal sc...