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Suggest medical tests to rule out malignant stenosis

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Posted on Wed, 4 May 2016
Question: I had some microscopic amount of blood in the urine and I went to a urologist. He ordered a Cat Scan which showed a stenosis in the left ureter tube about midway down from the kidney to the urethra. The urologist wanted to go in and see with a small instrument, but it would require general anesthesia in the hospital and would have to have someone drive me home (which I have none to do that). Being very afraid of general anesthesia, I cancelled the procedure. My question is, is there another way to determine if the stenosis is malignant or requires something to be done? i.e. doing an MRI? It's been 6 months since the diagnosis and I do not want to delay much longer. Thank you.
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Answered by Dr. P. T. Patil (4 hours later)
Brief Answer:
There is nothing to be worried about General anesthesia

Detailed Answer:
Hello
Thanks for your query ,based on the facts that you have posted it appears that your routine urine analysis has revealed presence of Blood in urine and subsequent CT has revealed presence of narrowing of left ureter .

The narrowing of ureter (Stricture) is mostly may be due to one of the following few common reasons
1) Inflammatory stricture
2) Mass obstructing lumen of the ureter may be either benign like Papiloma or Malignant
3) Extra luminal pressure over ureter due to any mass or enlarged abdominal lymph node .

The precise nature of the lesion can be ascertained only on direct visualization of the ureter and taking a small piece of lesion for histo- pathological examination (Biopsy) by an endoscopic procedure called Ureteroscopy which requires to be done under either General Anesthesia or Spinal Anesthesia .

If you are scared of general anesthesia you may request your Urologist to carry out the procedure under spinal anesthesia so that you can drive home yourself on next day..

As regards your query about any alternative method to diagnose the same you can get radiological test called Intra Venous Pyelography (I.V.P.)done which will visualize entire Urinary system and help us in diagnosis about the nature of blockage .However it has its own limitations in the sense that we are unable to find out whether the lesion is benign or malignant and pathological nature of the lesion which is very important factor to decide about modality of treatment .

I will suggest you not to get worried about anesthesia and get the Ureteroscopy done under spinal anesthesia .

Hope I have answered your query ,please feel free to ask if you have more questions ,I shall be happy to help you
Thanks and Regards.
Dr.Patil



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. P. T. Patil

Urologist

Practicing since :1971

Answered : 10391 Questions

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Suggest medical tests to rule out malignant stenosis

Brief Answer: There is nothing to be worried about General anesthesia Detailed Answer: Hello Thanks for your query ,based on the facts that you have posted it appears that your routine urine analysis has revealed presence of Blood in urine and subsequent CT has revealed presence of narrowing of left ureter . The narrowing of ureter (Stricture) is mostly may be due to one of the following few common reasons 1) Inflammatory stricture 2) Mass obstructing lumen of the ureter may be either benign like Papiloma or Malignant 3) Extra luminal pressure over ureter due to any mass or enlarged abdominal lymph node . The precise nature of the lesion can be ascertained only on direct visualization of the ureter and taking a small piece of lesion for histo- pathological examination (Biopsy) by an endoscopic procedure called Ureteroscopy which requires to be done under either General Anesthesia or Spinal Anesthesia . If you are scared of general anesthesia you may request your Urologist to carry out the procedure under spinal anesthesia so that you can drive home yourself on next day.. As regards your query about any alternative method to diagnose the same you can get radiological test called Intra Venous Pyelography (I.V.P.)done which will visualize entire Urinary system and help us in diagnosis about the nature of blockage .However it has its own limitations in the sense that we are unable to find out whether the lesion is benign or malignant and pathological nature of the lesion which is very important factor to decide about modality of treatment . I will suggest you not to get worried about anesthesia and get the Ureteroscopy done under spinal anesthesia . Hope I have answered your query ,please feel free to ask if you have more questions ,I shall be happy to help you Thanks and Regards. Dr.Patil