Medicines for the treatment of renal artery stenosis. Methods for diagnosis and treatment of renal artery stenosis. Etiology and pathogenesis

The human kidneys perform their functions constantly and without interruption. Their functions for the body are priceless. Main function— purification of blood from toxic substances, performed around the clock. The structure of the renal system is complex, each separate body performs its functions. The renal artery delivers blood to the kidneys. This paired blood vessel supplies medulla and cortex.

There are two renal arteries. Both normally work the same way and each supplies blood to the right and left, respectively, there is a left renal artery and a right one. They originate from abdominal aorta. Their length is short. Both are divided into a number of smaller ones. All segmental branches are divided into interlobar branches, which consist of arcuate arteries. In turn, they are distributed into capillaries, which pass into the renal arteries and veins.

Accessory renal artery is a very common disease, in which case the blood supply comes from the accessory artery. The additional ones are smaller in diameter than the main ones.

If it happens gradual narrowing or complete blockage of the lumen, the functional functioning of the renal system deteriorates. Such pathologies can lead to renal failure or increased blood pressure. All changes renal arteries must be monitored to exclude more serious pathologies.

The peculiarity of renal blood flow is its abundance in relation to other blood supply systems in the body. Also, the blood supply to the kidney has the property of self-regulation. When pressure increases, muscular system contracts, while blood flows in significantly smaller volumes, which leads to a decrease in pressure. At strong decline pressure, the blood vessels dilate and the pressure rises. In the glomerular system, pressure is at a constant level.

To maximum amount toxic substances have been removed, the entire blood flow passes through the system in just 5 minutes. It is very important to maintain healthy blood circulation and the condition of the renal arteries, as they are extremely important for humans. If the renal arteries do not function fully, then kidney function will deteriorate, which means general state the body will be at risk.

Renal artery blockage

Narrowing of the renal arteries can occur with two or one at once. As a rule, the course of the disease is not rapid. The appearance of blockage of the main veins, or any of their branches, is very dangerous. This happens as a blood clot. The blood clot moves through the bloodstream from anywhere in the body and stops in the renal artery, which leads to complete closure of the lumen. Most often, blood clots break off from larger ones that form in the heart or aorta.

Damage to the walls itself can lead to the formation blood clot, which will subsequently affect the blockage. Damage may occur due to surgical intervention or after an angioplasty or angioplasty procedure. Under the influence of atherosclerosis, blood vessels gradually collapse and clots form. Also destroying the arteries is a slowly forming expansion called an aneurysm.

Damage to the renal artery leads to blockage, however, in addition to blockage, rupture of the walls can also occur, so pathologies that can lead to the appearance of clots must be eliminated immediately after detection. If a blood clot does not form, some pathologies can lead to significant narrowing, which will reduce the nutrition of the kidneys. A disease in which the walls narrow, but a clot does not form, is called stenosis.

Renal artery stenosis

Renal artery stenosis dangerous pathology. Stenosis is essentially a narrowing of the diameter of blood vessels. During normal functioning, blood filtration leads to the formation of primary urine. When the walls narrow, the blood volume decreases; the stronger the narrowing, the less blood nourish the kidneys. Lack of blood leads to increased blood pressure, and the organ cleans the blood much worse.

Renal artery stenosis completely disrupts the functioning of the organ. With a critical decrease in blood volume, as well as with poor nutrition for a long time, the kidneys stop functioning normally and urine is not formed or excreted. Stenosis occurs due to certain diseases. Atherosclerosis can provoke stenosis, diabetes, aneurysm, some inflammatory processes, as well as neoplasms in the renal arteries.

In order not to provoke the appearance of stenosis, this disease has an extremely negative effect on the condition of the kidneys, as well as on general health person, there is a very high risk serious illness. If not applied in time therapeutic measures, then stenosis can lead to disruption hormonal levels, decreased protein levels, swelling and decreased fluid secretion, decreased amount of plasma.

Renal arteries of the elderly

Arterial walls throughout the body tend to thicken with age. The renal arteries thicken more slowly than others. In old age, the thickness of the renal arteries is finally formed. This happens from the moment of birth. If right renal vein thickened significantly, then such a process is observed in the left and vice versa.

In newborns, the inner shell of the hyperplastic thickening bifurcates into two membranes. As the body matures, the elastic lamina is divided into membranes many times. There is an increase in the number of membranes at the beginning of the arteries, as well as at the site of the first division into two separate branches, then this spreads along the entire perimeter of the bifurcated arteries.

In older age, changes lead to the appearance of an elastic layer with connective tissue and elastic fibers.

Age-related changes do not always lead to development pathological processes in the human body. Thickening occurs in any person and leads to the formation of sufficiently thick walls that can withstand damage. The simple structure of the blood supply in newborns copes well with light loads and small volumes of blood, but as the body grows, all processes become much more complex, and accordingly, the thickening of the walls, inherent in nature, is advisable.

Diagnosis of changes

During the examination, the doctor may rely on the collection of anamnesis to prescribe laboratory or instrumental methods diagnostics The main symptoms of changes in the condition of the renal artery:

1. Increased arterial pressure.
2. A blood test reveals an increase in red blood cells.
3. Decreased urine volume and frequency of urination.

These symptoms are also characteristic of other pathologies, so when making a diagnosis you cannot rely only on these symptoms. To study the condition of blood vessels, a special Doppler device is used, which determines how quickly blood moves through the blood supply system. Wall stenosis is successfully determined by this method, however, the device may not be able to distinguish slow blood flow.

Introduction contrast agent iodide composition is typical for radiography or fluoroscopy, which also successfully determine the condition of the renal artery and possible violations. The introduction of galium during MRI has the highest exact method conducting research that will allow you to fully study the state of the entire system, as well as each individual vessel. With this method, it is possible to determine diseases even at early stages occurrence.

The renal artery is one of the most important and significant blood vessels V human body. Narrowing of its lumen (stenosis) or complete blockage (occlusion) causes disruption of the blood supply, and therefore the functionality of one or both kidneys, depending on whether one or two-sided pathological process occurs.

Renal artery stenosis is a complex and dangerous disease, one of the nephropathic diseases, leading to the development of renovascular hypertension and a decrease in the quality of the renal blood supply. in turn causes the patient to develop hypertension. Renal artery stenosis is a disease that affects both men and women. However, representatives strong half of humanity are more likely to get sick in old age and they suffer from an atherosclerotic type of disease, and women and girls of any age are at risk rare view diseases – fibromuscular dysplasia.

Causes of the disease

Such a large blood vessel as the renal artery carries a significant load, ensuring high-quality blood flow and circulation in the kidneys. The consequence of the development of VA stenosis is pronounced arterial hypertension, which is difficult to correct. Not only nephrologists, but also cardiologists treat the disease and monitor the patient. Understanding the reasons why renal artery stenosis occurs in the human body, doctors point to the existence of conditions that result in this disease.

With atherosclerosis, the appearance of atherosclerotic plaques on the walls of blood vessels inevitably leads to the development of stenosis (narrowing of the lumen) and disruption of the quality and volume of blood flow. The cause of atherosclerosis, against the background of which renal artery stenosis develops, can be:

• obesity of any stage;
• hyperglycemia;
• hypertonic disease;

All of these conditions are typical for older men. The location of the plaques is such that there is also a danger for the aorta, and the area of ​​branches in the renal parenchyma is affected much less frequently.

Fibromuscular dysplasia is quite rare form disease, the development of which is associated with genetic inheritance. Renal artery stenosis in this case is caused by hardening of the vessel wall. In this case, narrowing of the lumen of the artery is possible not only in one, but more often in the right and left kidneys. FMD is a congenital pathology; the pathological process affects the anterior wall of the vessel and in most cases is bilateral.

Pulsed Dopplerography of the right and left renal arteries

Quite rare, but still occurs, renal artery stenosis caused by:

• inflammatory process;
• aneurysm;
• thrombosis;
• embolism;
• prolapse of the kidney.

In some cases, the development of the disease is associated with the presence malignant tumor, located in abdominal cavity and putting pressure on organs and blood vessels.

The disease can develop, affecting one or both kidneys. A bilateral pathological process poses a great danger to the patient’s health, because the functionality of both organs is impaired. The reason that caused the development of a process affecting both renal arteries may be hereditary, congenital pathology, atherosclerosis or hyperglycemia.

Symptoms and treatment of kidney pressure

Features and symptoms of the disease

Renal artery stenosis is in most cases closely associated with changes in blood pressure levels. In the body of patients suffering from SPA, due to the fact that blood circulation and blood flow in the kidneys are disrupted, the level of blood pressure also changes. The production of the hormone renin and angiothesin increases, the level of formation and production of the enzyme that provokes spasm increases small vessels. Resistance increases in peripheral vessels and arterioles. The result is the development of hypertension.

If renal artery stenosis is detected, treatment is prescribed in accordance with the severity of the disease. First of all, the manifestations of hypertension are eliminated by conservative treatment. Mandatory condition successful therapy is complete failure from all of us bad habits, changing the diet and level of exercise. Special attention patients suffering from obesity of any degree deserve. They need to make every effort to achieve positive result in the fight against excess weight.

Conservative therapy is more of an auxiliary nature; the main actions are related to the selection and prescription of the most effective medicines, the action of which is aimed at eliminating the manifestations of hypertension and restoring normal blood pressure. The doctor prescribes medications that help normalize blood flow, relieve spasms and eliminate negative manifestations concomitant diseases.

To achieve maximum positive effect When treating renal artery stenosis, a decision is often made about the need to treat the disease in other ways. It could be:

• balloon angioplasty;
• stenting;
• bypass;
• resection of a portion of the kidney and its restoration through prosthetics.

In the most difficult cases doctors decide on the need to remove the affected kidney and transplant a healthy organ.

Video: Denervation of the renal arteries

Renal artery stenosis is a disease caused by narrowing or blockage of the renal arteries. Data from epidemiological studies indicate that the pathology occurs in 6.8% of people over the age of 65 years. The danger of the pathology is that in 73% of cases during its natural course over seven years, patients die.

In patients with renal artery stenosis, blood flows to the kidneys very poorly and in much less quantity than necessary, which leads to a deterioration in the filtration process and increased pressure. Poor circulation also causes kidney failure. If long time If the disease is not treated, the kidney will shrink and will no longer be able to perform its functions. The disease in general has a negative impact on the patient’s health: it disrupts hormonal balance, protein loss occurs, the total blood volume changes, and the condition of blood vessels worsens.

Causes of renal artery stenosis

The main causes of stenosis include atherosclerosis (70% of cases), fibromuscular dysplasia (25%), nephrological pathologies (5%).

Atherosclerosis

Most often, renal artery stenosis provokes atherosclerosis. This term refers to the process of accumulation of plaque from cholesterol, fats and calcium on the renal arteries, which causes them to narrow. The risk of getting this disease increases with age. Patients with aortic lesions are at risk, arterial hypertension, defeat iliac arteries. This pathology is characterized by damage to one group of vessels due to stenosis, sclerosis, obliteration of arteries, and atherothrombotic disorders. Often, stenosis is located in the proximal segments of the renal arteries near the aorta, in the middle segments, at the bifurcation of the arteries, in the distal branches of the renal arteries.

Fibromuscular dysplasias

Fibromuscular dysplasia occurs due to congenital or acquired arterial dysplasia (thickening of the lining of the arteries). Often this pathology is diagnosed in women between 30 and 40 years old. Such a lesion is found in the middle segment of the renal artery.

Nephrological pathologies

Nephrological pathologies are the least likely cause of stenosis. Such pathologies include aneurysms, hypoplasia, occlusion and external compression of the renal arteries, vasculitis, thrombosis, nephroptosis, arteriovenous shunts.

Doctors also identify several risk factors that contribute to the disease. Such predisposing factors include:

• smoking;
• poor nutrition (predominance of foods with increased content sugar, fat and cholesterol);
• obesity;
• genetic predisposition;
• chronic kidney disease;
• increased blood glucose and cholesterol;
• elderly age.

Symptoms of renal artery stenosis

Pass the comprehensive examination A nephrologist should see patients who are concerned about the following conditions:

• Kidney failure - appears due to impaired functioning of the kidneys, caused by a slowdown in their blood supply due to a decrease in the diameter of the arteries.
• High blood pressure, which cannot be reduced by prescription antihypertensive drugs.
• The appearance of noises that can be detected when examining the abdomen with a stethoscope.
• Increased blood pressure (severe or moderate) in patients with a history of stroke or myocardial infarction.
• Increased blood pressure in patients under 30 years of age and over 50 years of age.
• Impaired kidney function after taking antihypertensive medications such as an angiotensin receptor blocker or an angiotensin-converting enzyme inhibitor.

Thus, we can say that renal artery stenosis is found in patients with hypertension and impaired renal function. TO general symptoms renal artery stenosis include: dizziness, sleep disturbance, shortness of breath, rapid heartbeat, muscle weakness, memory loss, lower back pain, emotional instability, the appearance of spots before the eyes, swelling in the ankles, vomiting and nausea, decreased or increased urination.

Diagnosis of renal artery stenosis

1. Laboratory research. An increase in blood urea nitrogen and serum creatine are the first indicators of the disease that the doctor pays attention to. To make a diagnosis, a urine test is also prescribed, which shows, if the disease is present, scanty urinary sediment and proteinuria.
2. Duplex ultrasound of the renal arteries is the most accessible and accurate method for diagnosing the disease, which allows you to assess the severity of stenosis by assessing the speed of blood flow in the arteries. The presence of pathology will be indicated by accelerated blood flow provoked by narrowing of the arteries. However, it is worth considering that in patients with obesity or flatulence, ultrasound results may be unreliable.
3. Renal scintigraphy: indicated to compare perfusion of the left and right kidney. This method is also used to measure glomerular filtration rate in the kidneys.
4. Magnetic resonance angiography. This technique allows you to obtain images of the renal arteries and aorta. The advantages of MRI for diagnosing stenosis are its non-invasiveness and the ability to obtain a three-dimensional image of the affected part of the artery. However, this technique also has disadvantages: high cost, overestimation of the severity of stenosis, and the inability in some cases to distinguish stenosis from occlusion.
5. Selective renal arteriography: allows you to determine the extent and location of arterial damage. It is carried out by introducing radiocontrast agents.

Treatment of renal artery stenosis

Initially, treatment for renal artery stenosis involved removal of the affected organ. But nowadays there are effective surgical and conservative techniques eliminate this disease.

Drug treatment of pathology depends on its stage:

• First stage (moderate hypertension). At this stage of the pathology, the patient experiences wellness And normal operation kidneys, the pressure is normal or exceeds its upper limit. To treat stenosis, your doctor may prescribe antihypertensive or diuretic medications.
• Second stage (compensation). Clinical picture The disease at this stage is more pronounced: persistent hypertension appears, renal dysfunction is observed, as well as their decrease. The patient needs complex treatment under the supervision of a doctor.
• Third stage (decompensation). The patient has severe hypertension, which cannot be eliminated with the help of antihypertensive drugs; the kidneys practically stop working and significantly decrease in size. Since the patient’s health condition is rapidly deteriorating, his treatment is carried out exclusively in a hospital setting.

At all stages of the disease, doctors usually prescribe medications from the groups of angiotensin II receptor blockers and ACE inhibitors. To lower cholesterol in the blood and stabilize atherosclerotic plaques in the arteries, medications from the class of statins are prescribed.

For effective treatment stenosis, smoking cessation and weight loss in case of obesity are recommended. In addition, it is necessary to follow a low-carb diet, which will help lower blood sugar levels and thereby prevent diabetic lesion kidney Such a diet will also help lower blood cholesterol levels, which will slow down the development of both atherosclerosis and stenosis.

Surgery

In difficult cases, treat stenosis with conservative methods fails, so it is necessary to resort to surgery. Usually surgery is prescribed when following indications: unstable angina or pulmonary edema in the presence of hemodynamically significant stenosis, chronic renal failure, arterial stenosis in the presence of one working kidney, uncontrolled hypertension, bilateral hemodynamically significant stenosis.

• Bypass surgery is the creation of another path for blood flow (bypassing the affected area of ​​the artery) using shunts.
• Angioplasty is the expansion of a narrowed vessel by inserting an inflating balloon into it.
• Stenting is the expansion of the renal artery using a mesh or springy stent, which is placed inside the vessel, thereby expanding it and improving blood flow.
• Arterial section resection - removal of the affected section of the artery.
• Prosthetics is a reconstructive operation that is usually performed after renal artery resection. It is prescribed to restore normal blood flow by replacing a renal artery implant.
• Nephrectomy is radical method treatment of pathology, which involves complete removal of the affected organ.

Prognosis for renal artery stenosis

Untimely treatment of the disease can provoke consequences such as stroke, kidney and heart failure, and vascular atherosclerosis. When timely treatment When the pathology has not yet reached a severe stage, the prognosis for the patient is favorable. For full recovery After stenosis it will take about 4-6 months.

To prevent renal artery stenosis you need to:

• take place once a year medical checkup to ensure that kidney function and blood pressure are normal;
• eat right - give preference lean meat, fruits, limit the consumption of salt, canned food, sweets, donuts, chips, butter, lard and milk;
• exercise regularly;
• maintain a healthy weight;
• give up alcohol and smoking;
• avoid emotional and physical stress;
• monitor pressure.

Kidney perfusion is reduced due to narrowing of the lumen of the renal arteries (usually one of them) when a person is faced with a disease such as renal artery stenosis. There are many reasons for the development of pathology, and the symptoms are pronounced. Treatment is carried out conservatively, but often necessary surgery. The prognosis is more favorable, but everything depends on the adequacy and timeliness of therapeutic procedures.

Narrowing of the patency of the renal artery is an acquired disease, with characteristic symptoms and treatable.

General information

Renal artery stenosis is a disease that occurs due to narrowing or blockage of the lumen large vessels, which ensure blood flow to the kidney. The disease is more common in older people. Statistics say that it occurs in every 7 elderly people. Against the background of the disease, blood flows to the organ in smaller quantities than necessary, which leads to poor filtration. Long-term problems with blood flow lead to kidney failure as the organ shrinks and is unable to function properly. These processes lead to a deterioration in the patient’s well-being.

Pathology refers to the areas of activity of nephrologist, urologist and cardiologist. It is a consequence of congenital or acquired problems with blood vessels. With stenosis, renovascular arterial hypertension develops, from which the kidney parenchyma does not suffer. But stenosis of the kidney arteries can lead to dangerous complications.

Reasons for development

The causes of renal artery stenosis can be divided into 3 groups:

1. Fibromuscular dysplasia (more typical in females, the pathology affects the middle or distal portion of the vessel):
   • dysplasia of the middle layer;
   • proliferation of the inner membrane;
   • subadventitial fibroplasia;
   • nonspecific aortoarteritis.
2. Atherosclerosis (7 out of 10 cases, more common in males, affects the mouth of the vessel).
3. Nephrological pathological conditions:
   • aneurysm;
   • hypoplasia;
   • vessel occlusion;
   • external compression.

The reasons that can provoke the development of pathological processes are:

• smoking;
• severe fullness;
• arterial hypertension;
• genetic predisposition;
• diabetes;
• age after 65 years;
• chronic kidney disease;
• elevated cholesterol levels.

When renal artery stenosis develops, the blood pressure in the section of the vessel decreases, which follows the narrowing. As a result, renin is released. This leads to a decrease in sodium levels in the nephron, causing the conversion of renin to angiotensin L, which, under the influence physiological processes affects the systemic arteriole. In addition, peripheral resistance increases. Over time, hypersecretion of aldosterone develops, the level of sodium in the body increases, which leads to swelling due to the accumulation of extracellular fluid. Sodium also contributes to the hypersensitivity of vascular walls to hormones and increased tone. As these processes develop, the symptoms of the disease increase.

Symptoms of kidney disease

Renal artery stenosis can manifest itself in different ways, which depends on many factors, but we can identify the main symptoms that are typical for most patients:

• headache;
• dizzy;
• pressure rises;
• memory becomes worse;
• sleep problems;
• noise in the ears;
• irritability, tearfulness, excessive emotionality;
• pain in the eye area;
• the appearance of glare in the eyes;
• dyspnea;
• tachycardia;
• chest pain that radiates to the heart and left arm;
• aching painful sensations in the lumbar region;
• my heart hurts;
• cottony legs.

Diagnostics

When a patient comes to the doctor, the specialist carries out the necessary diagnostic procedures. First of all, the doctor collects anamnesis (symptoms, complaints, family diseases, congenital and chronic diseases), palpates the abdomen, listens for noises in the upper abdomen and conducts visual inspection. This provides the necessary data for further research. If a specialist suspects renal artery stenosis, he will prescribe the following diagnostic procedures:

• general analysis of urine and blood;
• blood biochemistry (creatinine and);
• Ultrasound (visualizes a decrease in the ischemic organ);
• excretory urography (delay of contrast in the place where the narrowing occurred);
• X-ray contrast angiography (you can see exactly where the narrowing occurred and where the artery widened);
• radioisotope research;
• scintigraphy;
• duplex scanning of the renal arteries;
• differential diagnosis (with pheochromocytoma, primary aldosteronism, coarctation of the aorta).

• Stage I (moderate hypertension) - the functionality of the kidney does not change, there are practically no symptoms of pathology, only sometimes the pressure increases. Diuretics and drugs are used that stop the course of the attack.
• Stage II (compensation) - persistent hypertension develops, the kidney functions worse and decreases slightly. The therapy is deeper.
• Stage III (decompensation) - severe hypertension, the size of the kidney is significantly smaller than usual, which affects the functions of the organ and external symptoms diseases. Therapy only in a hospital inpatient setting.

Diseases of the urinary system affect approximately 35% of the total population globe. Approximately 25-30% are associated with kidney abnormalities. These include: renal artery aneurysms, multiple or double renal arteries, solitary artery, accessory renal artery, fibromuscular stenosis, etc.

Accessory renal artery - what is it?

Accessory renal artery is the most common malformation of renal vessels. This disease occurs in approximately 80% of cases in people suffering from kidney disease. An accessory artery is an artery that, along with the main renal artery, supplies blood to the kidney.

With this anomaly, two arteries depart from the kidneys: the main and the accessory. The accessory directs to the upper or lower segment of the kidney. Diameter accessory artery less than the main one.

Causes

The anomaly occurs during embryonic development; the cause of such deviations is not known for certain. It is assumed that for unknown reasons, a failure occurs normal development, as a result of which, doubling may occur in the renal artery.

Kinds

Several types of pathologies are known renal vessels– arteries depending on their number:

• Double and multiple. Double accessory artery is rare. The second artery, as a rule, is reduced and is located in the pelvis in the form of branches on the left or right.
• Multiple arteries are found in normal and pathological conditions. They depart in the form of small vessels from the kidney.

Types of accessory renal artery

Clinical picture

The disease is usually asymptomatic. It appears only when the urinary tract is crossed by an accessory artery.

Due to this crossing, the outflow of urine from the kidneys becomes difficult, resulting in the following clinical manifestations:

• Hydronephrosis - persistent and rapid expansion renal pelvis, which occurs due to a violation of the outflow of urine.
• Arterial hypertension is high blood pressure (BP). A jump in blood pressure occurs due to a decrease in fluid content in the body, the vessels narrow, blood flow becomes more difficult, and as a result, pressure increases.
• Kidney infarction. With prolonged hydronephrosis, gradual atrophy of the renal parenchyma occurs, which subsequently leads to infarction of the entire kidney.
• Formation of blood clots and bleeding at the intersection of the accessory artery and the urinary tract.

The kidney increases in size. There may be blood in the urine, and going to the toilet becomes painful. Patients complain about aching pain in the lower back and high blood pressure.

On palpation it develops pain syndrome in the form of attacks renal colic, pain can also radiate to the ribs, as with physical activity, and at rest.

Diagnostics

Most often, double and multiple renal arteries are diagnosed. With this deviation, the blood supply to the kidney is provided by two or more channels of equivalent caliber. The disease is difficult to determine, since similar renal arteries are observed in healthy kidney. They do not always organize pathology, but are often combined with other types of pathologies.

Availability Determination renal pathologies carried out using x-ray examination.

To determine special cases of anomalous renal arteries, use:

• excretory;
• Lower cavography;
• Renal venography;
• Aortography.

When a patient has a double or multiple renal artery, the resulting pyelograms make it possible to detect defects in the filling of the ureter, notice narrowings and kinks in the places where the vessel passes, and pyeloctasia.

To determine the anomaly of the solitary artery, aortography is used.

As common methods Minimally invasive techniques are widely used: ultrasound renal doppelography, MSCT, etc.

Treatment

What to do and how to carry out treatment is determined only after full diagnostics diseases. Treatment is based on restoring the physiologically normal flow of urine from the body. This effect can only be achieved through surgery.

Resection of the accessory artery. Removal can be complete or partial. Partial - the accessory artery and the damaged area are almost removed. Complete removal- removal of both the accessory artery and the entire kidney.

Resection urinary tract. This operation performed when resection of the accessory artery is impossible. The narrowed section of the urinary tract is removed and stitched back together.

The method of surgical intervention is determined by a urologist-surgeon individually for each patient.