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A ureteral obstruction occurs when one or both ureters become blocked. Ureters are the tubes that transport urine from the kidneys to the bladder. When these tubes are obstructed, it inhibits urine flow into and out of the bladder, which can cause pain and increase the risk of infection.
Ureteral obstruction is a common condition caused by a variety of factors such as scar tissue, ureteral stones, tumors, and others. If left untreated, urine can back up and cause kidney injury.
Untreated ureteral obstruction can cause symptoms that may quickly progress from mild to severe. In rare cases, it can lead to kidney failure, sepsis, or even death. However, these severe complications can usually be prevented with prompt treatment.
Symptoms
Symptoms and signs of a ureteral obstruction can vary depending on the location and severity of the blockage, as well as whether it affects one or both kidneys. If the obstruction is caused by a stone, patients may experience severe pain. When the blockage occurs gradually, symptoms may develop slowly over time. Mild symptoms can worsen quickly if left untreated. Common symptoms of a blocked ureter or urinary tract obstruction include:
- Pain, usually in the abdomen, lower back, or sides below the ribcage.
- Changes in the amount of urine output
- Having trouble peeing or emptying the bladder
- Urine containing blood
- Recurring urinary tract infections
- Hypertension
- Fever, nausea, or vomiting
- Urine that has a crimson or hazy appearance
- One or both legs are swollen
If any of the signs and symptoms persist, consult a doctor right away. Symptoms may get worse when left untreated. It may be urgent when there is an intense pain accompanied by nausea, vomiting, fever, or chills. In addition, consultation is necessary for people with intense pain that prevents them from sitting still or finding a comfortable posture, who has blood in their urine, or who have difficulty urinating. It is critical to consult the doctor for a diagnosis and treatment.
Causes
The ureter may get blocked due to several causes. The following are some of the causes of ureteral obstruction:
- Duplicated ureter: Duplicated ureter is a congenital condition in which two ureters develop in the same kidney, either completely or partially. This disorder can lead to urinary backup and kidney damage if one or both ureters fail to function properly.
- Obstruction in the ureteropelvic junction: The Condition of ureteropelvic junction obstruction can be present at birth, or it may develop due to factors such as injury, scarring, or malignancy. The ureteropelvic junction is the area where the ureter and kidney meet, and any obstruction in this area can cause urine to back up into the kidneys. If the ureterovesical junction gets blocked, it can obstruct the flow of urine, leading to kidney enlargement and eventual failure.
- Ureterocele: A ureterocele usually develops in the section of the ureter closest to the bladder, and it can result in kidney damage by obstructing the flow of urine and causing it to back up into the kidney. A ureterocele can form when the ureter is too narrow to permit proper urine flow.
- Retroperitoneal fibrosis: Fibers can develop due to malignant tumors or as a side effect of certain migraine medications. These fibers can wrap around and obstruct the ureters, leading to urine backup in the kidneys. This condition typically arises when fibrous tissue accumulates behind the abdomen.
- Other causes of ureteral obstruction: Ureteral obstruction can be caused by a variety of factors both intrinsic and extrinsic, such as kidney stones, benign prostatic hyperplasia, blood clots, tumors, swollen lymph nodes, or gastrointestinal problems like Crohn’s disease and diverticulitis.
Chronic enlargement of the ureter wall, commonly caused by tuberculosis or a parasitic illness known as schistosomiasis can also lead to ureteral obstruction. Pregnancy, endometriosis, or uterine prolapse are all possibilities.
Diagnosis
If a ureteral obstruction is suspected by your healthcare provider, they may recommend tests that include:
- Blood and urine tests: Examination of the urine and blood for evidence of infection, which may indicate that the kidneys are not performing properly. The test included creatinine level of the individual.
- Computed tomography (CT) scan: A CT scan is a cross-sectional imaging of the kidney, ureter, and bladder. This test uses X-rays and computers to create detailed images of the structures inside the body.
- Magnetic resonance imaging (MRI): MRI scans provide clearer images of the organs and tissues than regular X-rays and CT scans. It can give a comprehensive view of the urinary system using a magnetic field and radio waves. This is frequently recommended for people who are not eligible for X-rays due to radiation exposure.
- Ultrasound: This is an imaging test that uses high-frequency sound waves to examine the interior of the human body. Specifically, retroperitoneal ultrasound allows the doctor to visualize the area behind the abdominal organs, such as the kidneys and ureters, and can aid in determining the location and cause of the obstruction.
- Bladder catheterization: This procedure involves inserting a catheter tube into the urethra, injecting a dye into the bladder, and taking X-rays of the kidneys, ureters, bladder, and urethra before and after urination. Catheterization can help detect incomplete or obstructed urine flow.
- Renal nuclear scan: This test evaluates the urinary system using a special camera that can detect radioactivity and produce images. During this procedure, a tracer containing a small amount of radioactive material is injected into the arm.
- Cystoscopy: The urethra and bladder are examined with the help of a cystoscope, a small tube equipped with a camera and light. The doctor may need to make a small incision to insert the equipment into the urethra.
Treatment
The treatment for ureteral obstruction is based on the cause of the blockage. Generally, treatment options may include special procedures, surgery, and antibiotics to treat related infections. Patients may be advised on the best procedure or combination of procedures beneficial for them. Depending on the circumstances, drainage methods may provide temporary or permanent relief.
- Medication: In cases where an enlarged prostate is causing blockage, physicians may recommend treatment with either an alpha-blocker, which works by relaxing the muscles surrounding the prostate, or with finasteride, a medication that can shrink the size of the prostate gland.
- Drainage procedures: To begin, the healthcare provider will execute a treatment that will allow urine to drain from the body. This procedure may be used to temporarily alleviate the symptoms caused by the blockage, especially those with extreme pain. The doctor may recommend:
- Ureteral stent. A thin tube is inserted into the ureter to keep the ureter open and allow urine to drain freely.
- Percutaneous nephrostomy. During this treatment, doctors make an opening in the skin around the kidney called a nephrostomy. They put a catheter or tube into the hole and drain urine from the kidney directly.
- Catheter. This method is utilized if the obstruction is at the bladder’s outflow. The catheter is placed through the urethra to connect the bladder to a drainage bag outside the body.
- Surgical procedures: Following the drainage procedure, the doctor may need to address the underlying cause of the obstruction. The treatment approach is determined by the cause of the obstruction as well as the severity of the blockage.
Various surgical procedures are utilized to correct ureteral obstructions, and the choice of procedure depends on the individual’s specific situation. The surgical approach for treating ureteral obstruction may involve one of the following:
- Endoscopic surgery. This treatment can be used to both diagnose and treat a problem. During the procedure, an endoscope is inserted via the urethra into the bladder and other sections of the urinary tract. The doctor then cuts into the obstructed segment of the ureter to widen the region. A stent, a thin, flexible tube, can be inserted into the ureter to keep it open and allow urine to flow.
- Open surgery. If the obstruction is caused by a congenital abnormality or tumor, it can be removed surgically. To remove the blockage and repair the ureter, the doctor will need to make a cut in the abdomen.
- Laparoscopic surgery. The doctor will treat the obstruction using a laparoscope. The equipment and other instruments required for the treatment is inserted into the skin through one or more small incisions.
- Robot-assisted laparoscopic surgery. A laparoscopic procedure is performed by the surgeon using a robotic system.
