Ureteral Strictures

Ureteral Strictures: A Narrowed Ureter and What It Means for Your Kidneys

A ureteral stricture is a narrowing in one of the ureters, the two muscular tubes that carry urine from each kidney down to the bladder. Treatment for ureteral strictures ranges from minimally invasive endoscopic procedures that widen the narrowed segment to reconstructive surgery that removes or bypasses it entirely. The condition matters because a narrowed ureter puts the kidney under pressure: urine backs up, infection becomes more likely, and kidney function can decline gradually — sometimes with very little warning.

One point of naming deserves attention straight away, because it causes genuine confusion. The ureter is not the urethra. The urethra is the single tube that carries urine out of the body from the bladder, while the ureters sit higher in the urinary tract, connecting each kidney to the bladder. Both structures can develop a narrowing, but the causes, the symptoms and the treatments differ considerably. This page covers strictures of the ureter. If your diagnosis mentions the urethra instead, the pages on urethral strictures and urethra diseases describe those conditions.

For many patients, the diagnosis of a ureteral stricture comes after months of uncertain symptoms. Some people have intermittent flank pain, recurrent urinary tract infections, fever, nausea, blood in the urine, or worsening kidney test results. Others discover a stricture only when imaging is performed for another reason — kidney stones, cancer treatment follow-up, abdominal surgery, trauma, or a previous urinary procedure. That uncertainty can be distressing, particularly when the affected kidney is still working and the right treatment decision may determine whether its function can be protected.

Treatment focuses on restoring safe urine flow. In some cases, a minimally invasive endoscopic procedure is enough to open the narrowed area. In others, reconstructive surgery is needed to remove or bypass the scarred segment and create a durable channel for drainage. The right approach depends on the length and location of the stricture, its cause, kidney function, infection status, previous treatments and your overall health. At Acibadem, evaluation follows a structured diagnostic and treatment pathway that brings together urologists, radiologists, anaesthesiology teams, nephrology specialists when needed, and other physicians involved in your care. This coordination matters because decisions about drainage and reconstruction need to be accurate, timely and clearly explained before anything is scheduled.

Is the ureter the same as the urethra?

No. The ureter and the urethra are two different parts of the urinary tract, and the distinction shapes everything about diagnosis and treatment. You have two ureters, one running down from each kidney to the bladder; they work continuously, moving urine downwards with gentle muscular contractions. You have one urethra, which empties the bladder to the outside of the body when you urinate. The spelling ‘uretha’, which appears often in health searches, is simply a common misspelling of urethra — it does not refer to a separate organ. Because the words look and sound so similar, patients sometimes arrive with records that mix the two up. It is worth checking your own reports carefully: a ureteral problem concerns kidney drainage, while a urethral problem concerns bladder emptying.

How is a ureteral stricture different from a urethral stricture?

A urethral stricture narrows the tube below the bladder and typically causes a weak or spraying urinary stream, straining to urinate, dribbling, or a feeling of incomplete emptying. A ureteral stricture, by contrast, narrows a tube above the bladder, so urination itself may feel entirely normal while the kidney on the affected side silently swells under pressure. The treatments differ as well: urethral narrowings are managed with their own set of endoscopic and open techniques, including grafting procedures described under urethral reconstruction, whereas ureteral narrowings call for the stents, dilations and abdominal reconstructions described on this page. If you are unsure which condition applies to you, the location named in your imaging report — kidney, ureter, bladder or urethra — is the deciding detail.

What does “stricture” mean?

The stricture definition used in medicine is an abnormal narrowing of a hollow, tube-shaped structure in the body. Strictures can occur in many organs — the oesophagus, the bile ducts, the bowel, the urethra and the ureter among them. In the urinary tract, a stricture usually forms when injured tissue heals with scar rather than with normal, elastic muscle and lining. Scar tissue is stiff. It does not stretch, and it does not propel urine the way healthy ureter does, so even a short scarred segment can behave like a partial blockage. That is why the word appears so often in urology reports: it describes not just a narrow point, but a segment that no longer functions as living, working tube.

What is the medical term for ureteral stricture?

The medical term is simply ureteral stricture, and you may also see it written as ureteric stricture or ureteral stenosis — all three describe the same condition. Related terms often appear alongside it in reports. Hydronephrosis means swelling of the kidney caused by urine that cannot drain. Hydroureter means dilation of the ureter above the narrowed point. Obstructive uropathy is the broader term for any blockage that damages the urinary tract. Understanding these words makes imaging reports and specialist letters far easier to follow.

What Ureteral Stricture Treatment Involves

Ureteral stricture treatment includes a range of procedures designed to reopen, repair, reconstruct or bypass a narrowed segment of the ureter. The ureter is a delicate muscular tube, and when part of it becomes scarred, compressed, kinked or injured, urine may back up into the kidney. This backup — hydronephrosis — can lead to pain, infection or loss of kidney function if it is not corrected.

The goal of treatment is not simply to widen the ureter for the short term. A good plan aims to create stable drainage that stays open over time, preserves kidney function and reduces the need for repeated emergency interventions. In selected cases, temporary drainage with a ureteral stent or a nephrostomy tube is needed first. These measures protect the kidney and control infection before definitive treatment is performed; they are a bridge, not usually the destination.

The main options include endoscopic dilation, endoscopic incision of the stricture, ureteral stent placement, balloon dilation, robotic or laparoscopic reconstruction, open reconstructive surgery, ureteral reimplantation into the bladder, removal of the narrowed section with reconnection of healthy ureteral ends, and more complex repairs using tissue grafts or bowel segments. The terminology can feel overwhelming, but the underlying decision rests on practical questions: where is the narrowing, how long is it, what caused it, and how healthy are the remaining ureter and kidney?

Short strictures caused by stones or instrumentation can sometimes be treated endoscopically. Longer strictures, strictures caused by radiation, recurrent strictures after previous procedures, and strictures near the bladder or kidney more often require reconstructive surgery. Modern imaging and endoscopic assessment help the urology team choose the appropriate option and avoid procedures that are unlikely to last.

Who May Need Treatment for a Ureteral Stricture

Treatment becomes necessary when a ureteral narrowing blocks urine flow, causes symptoms, threatens kidney function or leads to repeated infection. Some strictures are discovered urgently; others are found during planned surveillance after another medical condition. The decision to treat depends not only on how you feel but also on what imaging and kidney function tests show — a point worth emphasising, because the two do not always agree.

What symptoms suggest a ureteral stricture?

Typical symptoms include pain in the side or back, abdominal discomfort, nausea, urinary frequency, burning during urination, fever or chills if infection is present, and blood in the urine. Pain may come and go, especially when the obstruction is partial. Some patients feel entirely well yet have hydronephrosis on ultrasound, computed tomography or magnetic resonance imaging. A silent obstruction can still be harmful, which is why follow-up matters whenever imaging suggests impaired drainage. The absence of pain is not proof that the kidney is safe.

Does a post-stent ureteral stricture cause intermittent pain?

It can. A stricture that develops after stent placement or after a previous ureteral procedure often causes pain that fluctuates rather than staying constant. The reason is mechanical: a partially narrowed ureter may drain adequately at rest but struggle when urine production rises — after drinking large volumes, for example — causing episodes of flank ache or pressure that then subside. Some patients notice discomfort in waves, similar to a mild version of stone pain. Intermittent symptoms are easy to dismiss, but a pattern of recurring one-sided flank pain after ureteral instrumentation is a recognised signal that drainage should be re-examined with imaging. Equally, a post-stent stricture can be painless, which is why surveillance imaging is usually arranged after procedures known to carry stricture risk.

How is a ureteral stricture diagnosed?

Diagnosis usually begins with a detailed medical history. Prior kidney stones, pelvic surgery, gynaecological or colorectal procedures, urinary tract procedures, radiation therapy, trauma, endometriosis, malignancy, inflammatory conditions and congenital urinary tract differences can all be relevant. Laboratory work may include kidney function tests, urine analysis, urine culture and assessment for infection or inflammation.

Imaging is central. Ultrasound can show swelling of the kidney, while computed tomography urography or magnetic resonance urography defines the level of obstruction and the surrounding anatomy. Nuclear medicine renal scans measure how well each kidney functions and how effectively urine drains. In some patients, retrograde or antegrade contrast studies map the ureter directly, showing the exact length and location of the stricture — information that is often essential before reconstructive surgery, because the operation chosen depends on precisely those measurements.

Patients are typically referred for stricture treatment after repeated stent exchanges, persistent hydronephrosis, recurrent infections, declining kidney function, pain despite conservative management, or failure of a previous endoscopic procedure. Many patients seek a second opinion when they have been told they may need long-term stenting, a nephrostomy tube or complex reconstruction, and want to understand whether a more durable option exists. Sometimes the answer confirms the original plan; sometimes it opens a different path. Either way, the value lies in precise assessment.

What Causes a Ureteral Stricture?

Most ureteral strictures are caused by injury to the ureter that heals with scar tissue — from stones, surgery, radiation, inflammation or external compression. The exact cause matters because it shapes both the choice of procedure and the expected durability of repair. A short scar after a stone procedure behaves very differently from a long radiation-associated narrowing, and treatment must be individualised accordingly.

• Strictures after kidney stones or stone procedures: Stones can injure the ureter directly, and procedures to remove them occasionally leave scarring in the upper, middle or lower ureter. If stones remain part of your picture, the page on ureteral stones explains how they are managed.
• Post-surgical ureteral injury: Narrowing can follow pelvic, abdominal, gynaecological, colorectal, vascular or urological surgery. Some injuries are recognised immediately; others become apparent weeks or months later, usually through hydronephrosis on follow-up imaging.
• Radiation-related strictures: Radiation therapy for pelvic cancers can reduce the blood supply to the ureter, producing longer and more complex strictures that demand careful reconstruction planning.
• Congenital or developmental narrowing: Some people are born with narrowing near the kidney or bladder — ureteropelvic junction or ureterovesical junction obstruction — which may only present in adulthood.
• Inflammatory or fibrotic conditions: Disorders that cause inflammation or scarring in the tissue around the ureter can compress or narrow the tube from the outside.
• Endometriosis-related obstruction: Endometriosis can involve or compress the ureter, creating partial or complete obstruction that may be silent until kidney swelling is detected.
• Cancer-related obstruction: Tumours within or near the urinary tract can narrow or compress the ureter; care is then coordinated with oncology specialists, and treatment priorities may differ. Growths arising in the ureter itself are covered under ureteral tumors.
• Recurrent or failed previous repairs: Persistent obstruction after dilation, incision, stenting or earlier surgery is itself an indication for reconstructive evaluation.

Not every narrowing requires immediate major surgery. Some patients need temporary drainage first, some are candidates for endoscopic treatment, and others benefit most from definitive reconstruction. The principle is to match the intensity of treatment to the severity of obstruction, the risk to the kidney, and the realistic likelihood of long-term success.

How Ureteral Stricture Treatment Is Performed

Treatment begins with preparation, and the sequence tends to follow a recognisable pattern:

• 1. Review: the team studies previous imaging, operative reports, stent history, infection history, kidney function, medications, allergies and overall condition. Bringing complete prior imaging and operative reports to this review shortens the diagnostic path considerably.
• 2. Stabilisation, if needed: infection is controlled and drainage is secured before any definitive procedure.
• 3. Definitive treatment: endoscopic widening or surgical reconstruction, chosen to fit the stricture’s length, location and cause.
• 4. Healing and stent removal: a temporary stent usually supports the repair while it heals.
• 5. Surveillance: imaging and kidney function tests confirm that drainage remains open over time.

When is drainage the first step?

Drainage comes first whenever there is infection, fever, severe obstruction or impaired kidney function. A ureteral stent can be placed internally, running from the kidney to the bladder to bypass the narrowed area. If a stent cannot pass, or urgent decompression is needed, a nephrostomy tube is placed through the skin into the kidney to drain urine externally. Neither is usually the final answer, but both can stabilise you, relieve pressure and make definitive treatment safer. Rushing to reconstruction through infected, swollen tissue is a risk no careful surgeon takes willingly.

Can dilation provide long-term relief from a ureteral stricture?

Sometimes — but honestly, not always, and the distinction depends heavily on the stricture itself. Endoscopic dilation works best for short, soft, recently formed narrowings with good blood supply, typically those following stones or instrumentation. Under anaesthesia, the urologist passes a thin camera through the urinary tract to the narrowed segment, widens it with a balloon or opens it with a controlled internal incision, and usually leaves a temporary stent to support healing. The appeal is obvious: no external incision, a shorter procedure and a quicker return to normal life. The limitation is equally real: scar tissue has a tendency to re-form. Long, dense, recurrent or radiation-associated strictures, and strictures in poorly vascularised tissue, carry a higher risk of narrowing again after dilation alone. When a stricture recurs after endoscopic treatment, repeating the same procedure indefinitely is rarely the durable answer — that is usually the point at which reconstruction enters the discussion. Your surgeon should be able to explain, before the first procedure, whether your particular stricture is a realistic candidate for lasting endoscopic relief.

What does reconstructive surgery involve?

Reconstruction is used when a more durable repair is needed, and the technique follows the anatomy. If the scarred section is short, the surgeon can remove it and join healthy ureter to healthy ureter — a procedure called ureteroureterostomy. If the stricture sits close to the bladder, the ureter can be reimplanted into the bladder, using techniques related to those applied in vesicoureteral reflux surgery to create a secure, well-draining junction. When more length is needed, the bladder itself can sometimes be mobilised and reshaped to reach the ureter without tension. For longer or more complex strictures, options include graft tissue — such as buccal mucosa taken from the inside of the cheek — or, in carefully selected cases, replacement of a ureteral segment with bowel.

Many of these operations can be performed laparoscopically or with robotic assistance when the anatomy allows. Minimally invasive approaches let the surgeon work through small incisions with magnified vision and fine instruments, which may reduce blood loss and support recovery in suitable patients. Open surgery remains important for complex cases: extensive scarring, prior radiation, multiple previous operations, or anatomy that requires direct access. The best approach is not the most technological one — it is the one that produces a precise, tension-free, well-vascularised repair.

Technology supports every stage. High-resolution cross-sectional imaging defines the obstruction and its neighbours. Contrast studies show the ureter’s anatomy and the stricture’s length. Endoscopic cameras give a direct view from inside the urinary tract. Intraoperative imaging or dye tests confirm drainage and identify the ureter during surgery. Laboratory monitoring tracks kidney function and infection control before and after treatment.

The duration of treatment varies widely. A stent placement or endoscopic procedure takes comparatively little time and may allow same-day discharge in selected cases. Reconstruction requires a longer operation and an inpatient stay for monitoring, pain control, urine drainage and early mobilisation; complex reconstructions require more recovery time and closer follow-up. After the procedure, most patients keep a temporary stent to support healing, and some also have a bladder catheter or a surgical drain for a limited period. The care team monitors pain, urine output, blood tests and infection signs, and provides instructions covering hydration, activity, medications, stent sensations and the warning signs — fever, worsening pain, inability to urinate, heavy bleeding — that would need review.

Stent removal is planned once the repair has had time to heal, and follow-up imaging is essential. A comfortable early recovery does not replace surveillance, because recurrence can follow any type of stricture treatment. Follow-up may include ultrasound, kidney function tests, urine testing and, in some cases, functional renal scanning or contrast imaging. Ask for copies of operative notes and imaging at discharge, so every physician involved in your later care can see exactly what was done.

What is it like to live with a ureteral stent?

Noticeable, for most people, but manageable. A stent is a soft, flexible tube that sits entirely inside the body, with one curl in the kidney and one in the bladder. Common sensations include urinary frequency and urgency, a mild burning at the end of urination, a dull ache in the flank or bladder area — often more pronounced after physical activity or towards the end of urination — and occasionally a pink tinge to the urine. These sensations vary enormously between individuals: some people barely register the stent, while others find it genuinely uncomfortable. Steady hydration, gentle activity and the comfort measures your team recommends usually make the interval tolerable. One practical point deserves emphasis: a stent is temporary equipment with a planned removal or exchange date. A forgotten stent left in place far beyond its intended lifespan can encrust with mineral deposits and become a problem in its own right, so the removal appointment is part of the treatment, not an optional extra.

What are the possible risks of treatment?

Every procedure on the ureter carries some risk, and a fair discussion covers it openly. Possible issues include bleeding, urinary tract infection, temporary urine leak at a repair site, stent-related discomfort, injury to nearby structures, reaction to anaesthesia and — the most important long-term concern — re-narrowing of the treated segment. Reconstructions that use bowel carry additional considerations related to the bowel itself. These risks are weighed against the risk of leaving an obstruction untreated, which includes progressive kidney damage and serious infection behind the blockage. How the balance falls depends on your anatomy, your kidney function and your general health, which is why the pre-operative discussion should always be specific to you rather than generic.

Does Flomax help a ureteral stricture?

Not as a treatment for the stricture itself. Flomax (tamsulosin) is an alpha-blocker that relaxes smooth muscle in the urinary tract; urologists sometimes prescribe it to ease stent-related discomfort or to help small ureteral stones pass. A stricture, however, is made of scar tissue, and scar does not relax in response to medication — no tablet can widen a fibrotic segment of ureter. So while an alpha-blocker may play a supporting role in comfort around the time of stenting, it does not open the narrowing or protect the kidney from obstruction. Whether any medication belongs in your individual plan is a decision for your treating doctor, made in the context of your full history.

Why Acting Early Matters

Ureteral obstruction can be deceptive. Some patients have severe pain that leads to quick diagnosis; others feel little discomfort even while the kidney sits under sustained pressure. If urine cannot drain adequately, that pressure gradually damages the kidney’s delicate filtering structures — quietly, and often without symptoms to mark the loss.

Delay raises the risk of recurrent urinary tract infections, kidney infections, stone formation, worsening hydronephrosis and loss of kidney function. Infection trapped behind an obstruction can become serious and may require urgent drainage. Chronic obstruction can also make later reconstruction harder, particularly if the ureter scars further or the kidney loses function before repair is attempted.

Early evaluation does not automatically mean early surgery. It means gathering enough information to choose the right timing and the right approach. Sometimes the safest first step is drainage and infection control. Sometimes imaging shows preserved kidney function, and reconstruction can be scheduled calmly. In other cases, urgent intervention is needed. Timely specialist assessment prevents avoidable deterioration and reduces the chance of repeated emergency care — which is, for most patients, the outcome they most want to avoid.

Benefits of Treatment

The potential benefits of ureteral stricture treatment depend on the cause and severity of the obstruction, but the central purpose is constant: restore drainage and protect the kidney.

Benefit	What It Means for You
Improved urine drainage	Relieves the obstruction so urine can flow from the kidney to the bladder safely and efficiently.
Protection of kidney function	Reduces pressure on the kidney and may help preserve remaining function, particularly when treatment comes before permanent damage.
Reduced pain and infection risk	May decrease flank pain, recurrent urinary infections, fever episodes and urgent hospital visits related to obstruction.
Less dependence on temporary tubes	Definitive reconstruction may reduce or eliminate the need for repeated stent exchanges or long-term nephrostomy drainage in suitable patients.
A personalised long-term plan	Follow-up imaging and kidney monitoring help detect recurrence early and support durable urinary tract health.

Recovery Timeline After Ureteral Stricture Treatment

Recovery differs between endoscopic procedures and reconstructive surgery, but the following timeline gives a realistic sense of what many patients experience.

Time Period	What You Can Expect
Day 1	Monitoring focuses on urine output, pain control, bleeding, infection signs and safe recovery from anaesthesia. Some patients go home the same day after minor procedures; others remain in hospital.
First week	Mild urinary discomfort, frequency, stent awareness, fatigue or incision soreness can occur. Walking, drinking fluids as advised and following medication instructions all support healing.
First month	Activity gradually increases. Stent or catheter removal is scheduled depending on the procedure, and follow-up tests assess healing and drainage.
Longer term	Ultrasound, kidney function tests or functional imaging confirm that the ureter remains open and the kidney is draining well.

What Influences the Result of Treatment

Outcomes after ureteral stricture treatment depend on several medical and technical factors, and it is worth understanding them before consenting to any procedure. The most important is length. Short strictures offer more treatment options; long strictures usually require more complex reconstruction. Location matters too: a narrowing near the kidney, in the middle ureter or near the bladder calls for different surgical strategies, because the tissue available for repair differs at each level.

The cause of the stricture strongly affects healing. Strictures related to stones or prior instrumentation behave differently from those caused by radiation, extensive surgery, cancer or inflammatory disease. Tissue quality and blood supply are decisive, because a durable repair requires healthy tissue that can heal. Previous operations, repeated stent placement, dense scar and a history of infection all add complexity — none rules out treatment, but each shapes the plan.

Kidney function before treatment is another critical factor. If the kidney has preserved function, restoring drainage helps protect it. If function has already declined substantially, the team must weigh whether reconstruction will deliver meaningful benefit. A functional renal scan is useful here: it shows each kidney’s contribution and the degree of drainage impairment, turning a difficult judgement into a measured one.

General health plays its part. Diabetes, smoking, vascular disease, immune suppression, obesity and active infection can affect wound healing and complication risk. Your full medication list, including blood thinners, is reviewed before surgery as part of planning — any adjustments are decided and directed by your treating doctors. For patients with cancer-related obstruction, treatment must align with chemotherapy, radiation therapy or oncological surgery, which is why multidisciplinary planning exists.

Technical principles decide much of the rest. The repair should be tension-free, correctly aligned and supported by healthy blood supply. The narrowed segment must be accurately identified, and the reconstruction must suit the true length and location of disease. Stenting and drainage need careful management. And follow-up is genuinely part of the result, because recurrence detected early — before symptoms return — is far easier to address.

Can a ureteral stricture come back after treatment?

Yes — recurrence is possible after every form of stricture treatment, endoscopic and reconstructive alike, because scar tissue can re-form as the treated segment heals. This is not a reason for pessimism; it is the reason surveillance exists. Recurrent narrowing is often silent, developing without pain while pressure quietly builds on the kidney, so scheduled imaging is arranged even for patients who feel completely well. Ultrasound can screen for renewed kidney swelling, and a functional renal scan can distinguish a ureter that merely looks dilated from one that is truly obstructed — an important distinction, since a ureter that has been stretched for a long time may remain wide on imaging even after drainage is restored. When recurrence is caught early, the range of options is wider and the kidney has lost less ground.

Your own participation matters as well. Taking antibiotics exactly as prescribed, attending stent removal appointments, avoiding heavy activity during early healing, staying hydrated according to medical advice and promptly reporting the warning signs your team describes all support recovery. Plan enough time for the initial healing period before returning to demanding work or long journeys, and make sure you leave with a written follow-up plan that your regular doctors can continue.

How Multidisciplinary Care Is Organised at Acibadem

A ureteral stricture is rarely just a surgical appointment. Patients need confidence that the diagnosis is accurate, the proposed treatment is appropriate, and the care pathway is organised around safety, communication and continuity. Ureteral strictures can be genuinely complex — especially after previous surgeries, radiation therapy, cancer treatment or repeated failed procedures — and a structured approach is what makes complexity manageable.

At Acibadem, urology teams manage both endoscopic and reconstructive treatment of urinary tract obstruction, supported by diagnostic pathways that can include advanced imaging, functional kidney assessment, endoscopic evaluation, laboratory testing and multidisciplinary review. For complicated cases, care involves collaboration among urologists, radiologists, nephrologists, anaesthesiologists, infectious disease specialists, gynaecological or colorectal surgeons, and oncology teams where the stricture relates to cancer or prior pelvic treatment. This kind of joint planning is particularly valuable when a patient has a single functioning kidney, reduced kidney function, extensive scar tissue, prior radiation, or a long history of interventions.

Treatment plans are individualised rather than built around a single technique. Some patients are best served by an endoscopic approach with careful follow-up; others need robotic-assisted, laparoscopic or open reconstruction; some require temporary drainage before definitive repair; and in selected complex cases, reconstruction uses grafting or substitution techniques. The aim, in every case, is the procedure that fits the anatomy and the patient’s wider medical situation.

Clear communication matters especially in urology, where patients need to understand stents, catheters, nephrostomy tubes, imaging studies and staged treatment plans before they can take an informed part in decisions. On discharge, patients receive documentation covering the procedure performed, the stent schedule and the surveillance plan, so that follow-up can continue without gaps wherever later care takes place.

A Care Plan Focused on Drainage, Kidney Protection and Long-Term Follow-Up

Ureteral strictures demand thoughtful management because the problem is both mechanical and functional: the ureter is narrowed, and the kidney depends on that channel to drain. Effective treatment starts with understanding the exact anatomy, protecting the kidney from ongoing pressure, controlling infection when present, and choosing the most appropriate method to restore flow.

For some patients that means a limited endoscopic procedure with attentive surveillance. For others, reconstructive surgery offers the best prospect of durable relief. The timing, the technique and the follow-up schedule should always be tailored to your diagnosis, your kidney function, your previous treatments and your circumstances — because in stricture care, the plan that lasts is the one built around the individual, not around a single favoured technique.