Ureteral Obstruction

1 What is Ureteral Obstruction?

Ureteral obstruction is blockage in one or both ureters. Ureter is the tube that carries urine from the kidney to the urinary bladder.

It is a curable condition, but if not treated, then it may lead to certain complications.

2 Symptoms

Signs and symptoms of ureteral obstruction includes:

  • Oligouria (decreased urination),
  • Pain in lumbar area,
  • Pain while urinating,
  • Edema of the face.

If there is complete obstruction, there may be complete absence of urination (anuria).

3 Causes

The causes of ureteral obstruction include:

  • Kidney stones that obstruct the ureters,
  • Compression of the ureters from outside by some tumor,
  • Tumor growth inside the ureter,
  • Spasm of ureter.

4 Making a Diagnosis

The diagnosis of ureteral obstruction includes:

  • physical examination,
  • history of the symptoms,
  • family history of kidney stones formation,
  • imaging tests.

X-rays (deviation in the ureter structure), blood tests(signs of infection) , urine analysis (presence of creatinine), intravenous pyelogram (contrast -ray of kidney, ureter and bladder), renal nuclear scan (radioactivity material screening), cystoscopy (a small tube with camera inserted into urethra to see the obstruction clearly), MRI (magnetic field is used to create detailed images), voiding cystography (dye is injected and X-ray is taken of the urinary system) or computerized tomography urogram (cross-sectional views is taken for better understanding) may help to confirm the diagnosis.

This condition can also be diagnosed in prenatal period by routine ultrasound.

5 Treatment

The main aim of the treatment for ureteral obstruction is to remove the obstruction and establish normal urine flow.

The following types of treatment procedures are available:

Drainage procedures are recommended when the ureteral obstruction causes severe pain which include a ureteral stent, percutaneous nephrostomy, a catheter.

Endoscopic surgery is a minimally invasive procedure in which a lighted scope is passed to the ureter and a cut is made at the area of blockage and widening the area with a stent.
Other surgical procedures include

  • Ureterolysis (the ureter is exposed and frees it from abnormal tissue)
  • Pyeloplasty (reopens or repairs the ureter)
  • Partial nephrectomy (removal of the damaged part of the kidney)
  • Ureteral reimplantation (poorly functioning part of the ureter is removed and the remaining parts are attached)
  • Transureteroureterostomy (the surgeon joins one ureter to the other for improvement in the renal function

The above mentioned surgical procedures can be open surgery, as a laparoscopic surgery or as a robot-assisted laparoscopic surgery. The main difference in these procedures is the time taken for recovery and the number and size of incision.

Ureteral obstruction may occur as a result of infectious diseases so antibiotic therapy may be required to get rid of the infection.

6 Risks and Complications

There are several risks and complications associated with ureteral obstruction.

Risks include:

  • problems with parathyroid gland,
  • increased calcium content in the body,
  • thyroid problems due to calcitonin,
  • genetic predisposition,
  • cancer of some organs surrounding ureter.

Complications of ureteral obstruction may lead to:

  • kidney failure,
  • toxic product accumulation,
  • uremia,
  • accumulation of crystals in joints leading to gout.

This condition may lead to coma and death eventually, if not treated.