Description

A ureteral obstruction is a blockage in one or both of the tubes (ureters) that carry urine from the kidneys to the bladder. Ureteral obstruction can be cured. However, if not treated, symptoms can quickly move from mild-pain, fever and infection-to severe-loss of kidney function, sepsis and death.

Ureteral obstruction is fairly common. Because it's treatable, severe complications are rare.

Symptoms

Ureteral obstruction may have no signs or symptoms. Signs and symptoms depend on the location of the obstruction occurs, whether partial or complete, the speed with which it develops, and if it affects one or both kidneys.

Signs and symptoms may include:

  • Pain.
  • Changes in the amount of urine produced (production of urine).
  • Difficulty urinating.
  • Blood in the urine.
  • Infections of the urinary tract.
  • High blood pressure (hypertension).

When to see a doctor

Make an appointment with your health care provider if you have signs and symptoms that worry you.

Seek medical attention if you experience:

  • Pain so severe that you can't sit still or find a comfortable position.
  • The pain is accompanied by nausea and vomiting.
  • Pain accompanied by fever and chills.
  • Blood in the urine.
  • Difficulty urinating.

Causes

Different types of ureteral obstruction have different causes, some of them are present at birth (congenital). They include:

  • A second (duplicate) ureter. This common condition, which is congenital, two ureters in the same kidney. The second ureter may be fully or only partially developed. If the ureter is not working properly, the urine can be backup in the kidney and cause damage.
  • A blockage (obstruction) where the ureter connects to the bladder or the kidney. This prevents the flow of urine. A lock where the ureter and the kidney meets (ureteropelvic junction) can cause the kidney to swell, and, finally, to stop working. This condition may be congenital or may develop with typical childhood growth, the result of an injury or scar, or in rare cases, develop from a tumor. A lock where the ureter and the bladder to meet (union ureterovesical) can cause urine to back up into the kidneys.
  • Ureterocele. If the ureter is too narrow and does not allow the urine to flow completely, a small bulge in the ureter (ureterocele) may develop. When a ureterocele develops, usually in the section of the ureter closest to the bladder. This can block the flow of urine and cause the urine back into the kidney, possibly leading to kidney damage.
  • Retroperitoneal Fibrosis. This rare disorder that occurs when the fibrous tissue grows in the area behind the abdomen. The fibers may grow as a result of cancer tumors or from taking certain medicines used to treat migraines. The fibers surround and block the ureters, causing the urine to accumulate in the kidneys.

Other possible causes

Various causes in your internal (intrinsic) or outside (extrinsic) the ureter can lead to ureteral obstruction, including:

  • Stones in the kidney.
  • Cancerous and non-cancerous tumors.
  • The blood clots.
  • Enlargement of the lymph nodes.
  • Internal tissue growth, such as endometriosis in women.
  • Long-term swelling of the ureter wall, usually due to diseases such as tuberculosis, or infection by the parasite called schistosomiasis.

Risk factors

Certain conditions present at birth may increase the risk of ureteral obstruction. Having kidney stones or stones in the bladder can also increase the risk of one of the ureters are blocked. Blood clots, tumors, certain growth of the tissues and the swelling of the lymph nodes may also be factors in the development of this condition.

Complications

Ureteral obstruction can lead to infections of the urinary tract and kidneys, which may be irreversible.

Diagnosis

Often, providers diagnose ureteral obstruction disorders before birth, during a routine prenatal ultrasound, which can show the details of the developing fetus, including the kidneys, ureters, and bladder. Vendors tend to perform another ultrasound after birth to re-evaluate the kidneys.

If your doctor suspects that you have a blockage of the ureter, some of these tests and scans may be used to reach a diagnosis:

  • Blood and urine tests. Your provider checks samples of blood and urine for signs of infection and the presence of creatinine, indicating that the kidneys are not working properly.
  • Ultrasound. An ultrasound of the area behind your abdominal organs (retroperitoneal ultrasound allows your provider to see the kidneys and ureters.
  • Bladder catheterization. For the test incomplete or blocks the flow of urine, your doctor will insert a small tube (catheter) through the urethra is used to inject a contrast medium into the bladder, and the taking of X-rays of the kidneys, the ureters, the bladder and the urethra before and during urination.
  • Renal Gammagraphy. Your supplier or to a technician injects a tracer that contains a small amount of radioactive material in your arm. A special camera detects the radioactivity and produces images that your provider uses to assess the urinary system.
  • The cystoscopy. A small tube with a camera and light is inserted into the urethra or through a small incision. The optical system allows the doctor to see the inside of the urethra and the bladder.
  • Computed tomography (CT scan). A ct scan combines a series of x-rays taken from different angles and computer processing to create cross-sectional images of the kidneys, ureter and bladder.
  • Magnetic resonance imaging (MRI). An abdominal MRI uses a magnetic field and radio waves to create detailed images of organs and tissues that make up the urinary system.

Treatment

The aim of the ureteral obstruction treatment is to remove the blocks, if possible, or to evade the blockade, which can help to repair the damage to the kidneys. Treatment may include antibiotics to cure the infections associated with them.

Drainage procedures

A ureteral obstruction that causes severe pain may require an immediate procedure to remove urine from your body and temporarily relieve the problems caused by a blockage. Your doctor (urologist) may recommend:

  • A ureteral stent, which is a hollow tube inserted into the inside of the ureter to keep it open.
  • Percutaneous nephrostomy, during which the doctor inserts a tube through the back to drain the kidney directly (percutaneous nephrostomy).
  • A catheter is a tube that is inserted through the urethra connecting the bladder to an external drainage bag. This can be especially important if the problems with the bladder can also contribute to poor drainage of the kidneys.

Your doctor can tell you what procedure or combination of procedures is best for you. Drainage procedures may provide temporary or permanent relief, depending on your condition.

Surgical procedures

There are a number of surgical procedures used to correct blockages ureteral. The type of procedure depends on your situation.

Ureteral obstruction surgery can be performed through one of these surgical approaches:

  • The endoscopic surgery. This minimally invasive procedure that involves passing a lighted scope through the urethra into the bladder and other parts of the urinary tract. The surgeon makes an incision in the blocked or damaged part of the ureter to expand the area, and then inserts a hollow tube (stent) in the ureter to keep it open. You can perform this procedure to diagnose and treat a condition.
  • The open surgery. The surgeon makes an incision in the abdomen to remove the blockage and repair your ureter.
  • The laparoscopic surgery. In this procedure, the surgeon makes one or more small incisions through your skin in order to insert a small tube with a light, a camera and other instruments needed for the procedure.
  • Robot-assisted laparoscopic surgery. The surgeon uses a robotic system to perform a laparoscopic procedure.

The main differences between these surgical approaches are the recovery time after surgery and the number and size of the incisions used for the procedure. Your doctor (urologist) determines the type of procedure and the best surgical technique for the treatment of your condition.

Preparing for your appointment

Depending on the frequency and the severity of your symptoms, you can make an appointment with your health care provider. Or, you may be referred immediately to a urinary tract specialist (urologist).

Here is the information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as fasting before a specific test. Make a list of:

  • Your symptoms, including any that seem unrelated to the reason for your appointment.
  • Key personal information, including major stresses, recent life changes and family medical history.
  • All medications, vitamins or supplements that you are taking, including the dosage.
  • Questions to ask your provider.

Have a friend or family member, if possible, to help you remember the information they give you.

For ureteral obstruction, basic questions to ask your provider include:

  • What is likely causing my symptoms?
  • Other that the most likely cause, what are other possible causes of the symptoms?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have these other health conditions. How can I best manage them together?
  • There are restrictions that must be followed?
  • You should see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your provider is likely to ask several questions, such as:

  • When did your symptoms begin?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

Avoid doing anything that seems to worsen your signs and symptoms.

Symptoms and treatment of Ureteral obstruction