Ureteral Obstruction: Causes, Symptoms, Diagnosis and Treatment

What is a Ureteral Obstruction?

The ureters are tubes that carry urine from the kidneys to the urinary bladder. Two (2) ureters are present in our body, one attached to each kidney. The upper portion of each ureter is in the abdomen, and the bottom half is in the pelvic region. In an average adult, the length of the ureter is about 10 to 12 inches.

When a blockage occurs in one or both of these tubes, it is called Ureteral Obstruction. Blockages can be partial or complete and slow the flow of urine, amongst other complications. Ureteral obstruction, if untreated, may lead to a fast escalation of symptoms from mild like fever, pain and infection to sepsis, loss of kidney function and death.

What are the symptoms of Ureteral  Obstruction?

Signs and symptoms depend on where and how quickly the obstruction develops, whether it affects one or both kidneys. The symptoms may be mild at first but can quickly become worse in some cases. These might include:

• Abdominal pain (on one or both sides)
• Reduced urine output
• Having difficulty urinating
• Blood in the urine
• High blood pressure or hypertension
• Urinary Tract Infections (UTIs)
• Swollen leg(s)

You should seek immediate medical attention if you have:

• Severe pain that does not allow you to sit still or find a comfortable position
• Pain accompanied by fever and chills 
• Pain accompanied by nausea and vomiting
• Difficulty passing urine
• Blood in your urine

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What Causes Ureteric Obstruction?

Different types of obstructions can be caused by various factors. The blockages can be intrinsic (inside the body) and extrinsic (on the outside). Some of them are congenital, that is, they are present at birth. They are as follows:

• Duplication of the ureter tubes: This common condition is a birth defect that can cause two ureters to develop on the same kidney. The second tube can function normally or may only develop partially. It can cause the urine to back up and cause kidney damage.
• Ureterocele: If the ureter is too narrow, restricting the smooth flow of urine. A tiny bulge (ureterocele) may develop on the ureter close to the bladder. It can also cause the urine to back up and lead to kidney damage.
• Ureteropelvic Junction (UPJ) Obstruction: This is a blockage occurring in the renal pelvis area (located at the upper end of each ureter) of the kidney. In UPJ Obstruction, the urine flow  is  slowed or completely stopped and generally affects only one kidney.

This abnormality can be a birth defect, result of scarring or injury, or develop because of a tumor.

• Retroperitoneal Fibrosis: This rare disorder is the growth of fibrous tissue in areas located behind the abdomen. These fibers may  grow due to certain types of cancer or specific medications. They end up encircling the ureters and block them.

Some other causes include ureteral stones (kidney stones that move to the ureter), gastrointestinal issues, blood clots, tumors, cysts, complications from pregnancy, endometriosis (in females), and long-term inflammation of the ureter wall caused by diseases like tuberculosis. 

How are such Obstructions diagnosed?

• Often, doctors detect these obstructions before birth during routine prenatal ultrasounds when the fetus is developing. In general, a doctor may order blood and urine tests  to identify an infection, which could suggest that your kidneys aren’t functioning efficiently. Retroperitoneal ultrasound, an ultrasound of the area behind the abdominal organs allows your doctor to view your kidneys and ureters.
• Renal nuclear scan: A technician or your doctor injects a tracer that has a small amount of radioactive material into the arm. A special camera is used to detect radioactivity and produce pictures/images that your doctor can use to evaluate your urinary system.
• Bladder catheterization: To test blocked or incomplete urine flow, your technician or doctor will insert a catheter (a small tube) through the urethra, injects a dye into the bladder, and takes X-rays of your urethra, bladder, ureters and kidneys before and during urination.
• Cystoscopy: A catheter (a small tube) with a camera and light will be inserted into the urethra or through a small cut/incision. The optical system of the catheter will allow your doctor to see inside the urethra and bladder.

CT & MRI scans also may be used to view the urinary system in detail.

Urologists (urinary tract disease experts), as well as Nephrologists (kidney specialists) generally work together to provide comprehensive care for people with Ureteral Obstruction. 

What are some complications that are associated with Ureteral Obstructions?

When urine builds up and is unable to leave the body, it starts to build up in the kidneys. It can lead to swelling of the kidneys that creates more serious issues like kidney failure, sepsis (a life-threatening complication from an infection), and sometimes even death. Hence, it is vital not to ignore symtpoms.

What are the possible treatment options?

The course of treatment is based on the reason for the Ureteral Obstruction. Generally, the doctors first perform a procedure  to  drain the urine from your body. Treatment may include antibiotics to help with associated infections. There are mainly two(2) types of treatment options:

1. Drainage procedures: Some ureteral obstructions cause severe pain and require immediate draining of urine output providing temporary relief. For this purpose, a urologist may recommend:

• A ureteral stent: A hollow tube is inserted into the ureter to keep it open.
• A catheter: A tube that goes through the urethra and connects the bladder to an external drainage bag. 
• Percutaneous nephrostomy: In this procedure, the doctor inserts a tube through your back that drains the kidney directly

2. Surgical procedures: There are many surgical approaches to treat a ureteral obstruction:

• Open surgery: An incision is made into your abdomen to carry out the procedure.
• Endoscopic surgery: A minimally invasive procedure where a scope is passed through the urethra into the bladder
• Laparoscopic & Robot-assisted surgery: A small incision is made through your skin, and a small tube with a camera and light is inserted and the procedure is done. Sometimes, a robotic system is also used to perform surgery.

The main difference between these procedures is the recovery time involved and the size of the incisions made.

Ureteral obstructions are common but can be treated with drainage/surgical procedures if detected early. If you experience any of the symptoms mentioned above, contact medical experts immediately.

Frequently Asked Questions (FAQs):

Q: Are Urinary Tract Infections (UTIs) and Ureteral Obstructions the same?

A: No, they are not the same. However, few symptoms of a blocked ureter are similar to those of a UTI, like severe abdominal pain and a lack of urine output.

Q: How can one prevent the occurrence of kidney stones?

A: Kidney stones are deposits of minerals and salts in concentrated urine. Prevention includes reducing sodium (salt) intake, avoiding certain foods and drinking plenty of water to help pass the stones.

Q: Are only men affected by Ureteral Obstructions?

A: People of all ages can experience a blocked ureter. Patients with kidney stones are at a higher risk for this obstruction. This obstruction is generally the result of a congenital disability in babies and small children.

Q: What are some medications that get prescribed?

A: For men, doctors may prescribe an alpha-blocker that helps relax the prostate muscles. Side effects can include dizziness, headaches, and fainting, so only take them if prescribed by a medical professional.

Q: What happens when only one(1) kidney is affected?

A: In cases where only one(1) kidney might be affected, the other kidney works well enough to prevent complete kidney failure.