Ureteral obstruction

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.