From the Guidelines
Periureteric stranding is a radiologic sign that indicates inflammation or irritation around the ureter, and its management depends on the underlying cause, which can be determined through further evaluation, including urinalysis, urine culture, and additional imaging studies, as recommended by recent guidelines 1. When periureteric stranding is identified, it is essential to determine the underlying cause, as it can be associated with various conditions, such as urinary tract infections, kidney stones, recent urologic procedures, or ureteral obstruction.
- The most common causes of periureteric stranding include:
- Urinary tract infections
- Kidney stones
- Recent urologic procedures
- Ureteral obstruction Treatment depends on the specific cause, and it may include:
- Antibiotics for infections
- Pain management and hydration for stones
- Intervention for obstructions The stranding itself is not a disease but rather a radiologic sign of an underlying process, which occurs due to inflammatory mediators causing fluid to accumulate in the fat surrounding the ureter, creating the characteristic hazy appearance on imaging, as described in recent studies 1. Most cases resolve with appropriate treatment of the underlying condition, though follow-up imaging may be necessary to ensure resolution, as recommended by recent guidelines 1. In cases where the underlying cause is an iatrogenic urinary tract injury, management may involve ureteral stenting, percutaneous nephrostomy, or surgical repair, depending on the severity and location of the injury, as described in recent guidelines 1.
From the Research
Periureteric Stranding
- Periureteric stranding is a term that is not explicitly defined in the provided studies, but based on the context, it can be inferred to be related to perirenal fat stranding (PFS), which refers to linear areas of soft-tissue attenuation in the perirenal space on non-contrast computed tomography 2, 3, 4, 5, 6.
- The provided studies focus on the relationship between PFS and various conditions, including ureterolithiasis, ureteral urothelial carcinoma, and acute pyelonephritis 2, 3, 4, 5.
Association with Ureterolithiasis
- A study published in 2023 found that patients with ureterolithiasis and perirenal stranding can be managed conservatively without prophylactic antibiotics, as long as there are no clinical or laboratory signs of renal failure or infections 2.
- Another study published in 2022 found that patients with ureteral stones accompanied by PFS are more prone to ureteral injuries and infectious complications, such as urinary tract infection, fever, and sepsis, after ureterorenoscopy 3.
Association with Ureteral Urothelial Carcinoma
- A study published in 2021 found that PFS is an independent prognostic factor for recurrence-free survival and cancer-specific survival in patients with ureteral urothelial carcinoma 4.
Diagnostic Tool for Acute Pyelonephritis
- A study published in 2017 found that PFS is not a powerful diagnostic tool for acute pyelonephritis, with a sensitivity of 72% and specificity of 58% 5.
Impact of Ureteral Double-J Stent Insertion
- A study published in 2018 found that ureteral Double-J stent insertion following ureterorenoscopy in patients with ureteral stones accompanied by PFS can increase postoperative infection-related complications 6.