Treatment of Scar Tissue at the Ureterovesical Junction (UVJ)

Initial Management

Ureteral stenting should be the first-line treatment for UVJ scar tissue to relieve obstruction and maintain urinary drainage, as recommended by the World Journal of Emergency Surgery 1
If initial stenting fails due to complete occlusion, percutaneous nephrostomy should be placed to relieve obstruction, according to Praxis Medical Insights 2
Antegrade access with conversion to a percutaneous nephroureteral stent may be required for complicated cases, as suggested by Praxis Medical Insights 2

If stent placement is unsuccessful due to complete occlusion, percutaneous nephrostomy with delayed surgical repair is indicated, as recommended by the World Journal of Emergency Surgery 1
In any ureteral repair procedure, stent placement is strongly recommended to reduce failures and strictures, according to the World Journal of Emergency Surgery 1

Partial lesions of the ureter should be initially treated conservatively with stenting, with or without a diverting nephrostomy, as recommended by the World Journal of Emergency Surgery 1
For distal ureteral injuries or strictures (including UVJ), ureteroneocystostomy (ureteral reimplantation into the bladder) is the preferred surgical approach, according to the World Journal of Emergency Surgery 1

In patients with urinary diversion, image-guided percutaneous antegrade access with either immediate or delayed conversion to retrograde percutaneous nephroureterostomy is often preferred, as suggested by Praxis Medical Insights 2
Internal double-J stents tend to occlude quickly in ileal conduits due to mucous plugging and may require more frequent changes, according to Praxis Medical Insights 2

Regular assessment of clinical parameters and imaging is essential to monitor treatment success, as recommended by the American Journal of Kidney Diseases 3
If enlarging urinoma, fever, increasing pain, ileus, fistula or infection develop, urinary drainage should be augmented via ureteral stent, percutaneous urinoma drain, percutaneous nephrostomy, or a combination, as suggested by Praxis Medical Insights 2