Ureteral Orifice Stricture After Transurethral Resection of Bladder Tumors Involving the Ureteral Orifice or Adjacent Area: Clinical Course and Outcomes

BACKGROUND/AIM: Ureteral orifice stricture after transurethral resection of bladder tumor (TURBT) involving the ureteral orifice or adjacent area has not been sufficiently characterized. This study investigated the incidence, associated factors, management, and outcomes of this unique clinical entity. PATIENTS AND METHODS: We retrospectively analyzed 60 patients who underwent TURBT around the ureteral orifice, including the ureteral orifice itself, between January 2023 and September 2025. Those with a history of ureteral orifice stricture, ureteral orifice recurrence after upper tract urothelial carcinoma, and prior ureterocutaneostomy, as well as patients who did not undergo postoperative stent removal were excluded. Ureteral orifice stricture was defined as hydronephrosis or ureteral orifice obstruction after TURBT requiring clinical intervention, or cases associated with flank pain or deterioration of renal function. RESULTS: Ureteral orifice stricture developed in eight patients (13.3%). The median time to detection was 4.2 months. No statistically significant factors associated with ureteral orifice stricture were identified. All patients with a stricture required additional intervention. Management included transurethral resection of the stricture followed by double-J stent placement in three patients, double-J stent placement alone in two, double-J stent placement after nephrostomy in two, and transurethral resection of the stricture alone in one. At last follow-up, five patients were stent free, two required stent exchange, and one developed recurrent stricture but did not wish to undergo repeat stent placement because of stent-related bladder irritation. CONCLUSION: Ureteral orifice stricture after TURBT involving the ureteral orifice or adjacent area occurred at a non-negligible rate and was usually detected within several months after surgery. Although definitive associated factors were not identified, all patients who developed ureteral orifice stricture required additional intervention, suggesting that this complication can impose a substantial clinical burden. Careful postoperative surveillance and individualized management are warranted.