Ureteral Obstruction: Causes, Symptoms, Risk Factors, Diagnosis and Treatment

A ureteral obstruction is a blockage in one or both of the ureters, which are tubes that carry urine from the kidneys to the bladder. Ureteric obstruction may be treated. Infection, fever, and discomfort are examples of basic symptoms that can quickly escalate to more dangerous ones including sepsis, loss of renal function, and even death if treatment is not received.

Urethral obstruction happens very often. Because it is treatable, severe complications are rare.

Causes Of Ureteral Obstruction

Numerous reasons, some of which are congenital (existing from birth), can lead to urinary blockage. Among them are:

• An additional ureter: Two ureters grow on the same kidney as a result of this common congenital abnormality. There could be a fully-developed or partially-developed second ureter. A malfunctioning ureter or ureters can cause urine to back up into the kidney, causing damage to the kidney.
• An obstruction or blockage at the ureter's kidney-bladder junction. Urine flow is halted as a result. The kidney may enlarge and eventually stop functioning if there is an obstruction at the ureteropelvic junction, which is where the ureter and kidney connect. This illness may run in the family, arise from normal childhood development, be the consequence of an accident, or scar, or, in extremely rare circumstances, arise from a tumour. 
• Blockages at the ureterovesical junction, the point where the ureter and bladder meet can result in urine backflow into the kidneys.
• Ureterocel: Small bulges called ureteroceles can form in the ureters when the ureters are too thin to allow urine to pass completely through. Typically, a ureterocele develops in the section of the ureter next to the bladder. This blockage of urine flow may cause urine to back up into the kidneys, which could result in renal damage.
• Retroperitoneal fibrosis: This rare illness is brought on by the formation of fibrous tissue in the area behind the abdomen. Certain migraine drugs or malignant tumours may cause the fibres to multiply. The outcome of this is that urine backs up into the ureters.

Numerous internal (intrinsic) or exterior (extrinsic) factors, including the following, can cause urinary blockage:

• Kidney-shaped stones.
• Tumours, whether they are cancerous or not.
• Thrombus
• Swollen lymph nodes.
• Expansion of interior tissue, as in women's endometriosis.
• Chronic ureter wall oedema, usually caused by parasite infections such as schistosomiasis or TB.

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Symptoms Of Ureteral Obstruction

Ureteric obstruction may not cause any symptoms at all. The indications and symptoms vary depending on the obstruction's location, severity, and rate of development as well as whether it affects one or both kidneys.

Signs and symptoms may include:

• Pain.
• Variations in the volume of urine you produce, or urine output.
• Having difficulties urinating.
• Blood in the urine.
• Urinary tract infections.
• Increased blood pressure, sometimes known as hypertension.

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Risk Factors Of Ureteral Obstruction

Certain congenital abnormalities may result in an increased risk of ureteral obstruction. The existence of kidney or bladder stones may further raise the chance of one of the ureters becoming blocked. This disease may arise as a result of tumours, blood clots, certain tissue growths, and enlarged lymph nodes, among other things.

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Diagnosis Of Ureteral Obstruction

Before delivery, ureteral obstruction diseases are often diagnosed by doctors during routine prenatal ultrasounds, which can reveal features of the developing baby, such as the kidneys, ureters, and bladder. Healthcare providers usually perform a second ultrasound after delivery to evaluate the kidneys.

If your doctor has any concerns, several of these scans and tests could be performed to identify an obstructed ureter:

• Examination of the urine and blood: Your doctor draws blood and urine samples to check for infection and creatinine, a sign of compromised kidney function.
• Ultrasound: Retroperitoneal ultrasonography is an imaging modality that looks past your abdominal organs to see your kidneys and ureters.
• Catheterization of the bladder: Your healthcare provider will perform urethral catheterization, inject dye into your bladder, and take pre- and post-urination X-rays of your kidneys, ureters, bladder, and urethra to look for incomplete or blocked urine flow.
• Nuclear scan of the kidneys: A tracer, which is a very small amount of radioactive material, will be injected into your arm by your doctor or a technician. Your doctor uses the images from a specialist radioactivity-detecting camera to assess your urinary system.
• Cystoscopy: Your urethra or a tiny incision will be used to introduce a tiny tube that contains a camera and light. The physician can see within the bladder and urethra thanks to the optical equipment.
• CT scan (computerised tomography): Using computer processing, a CT scan generates cross-sectional images of your kidneys, ureter, and bladder by merging many X-ray views taken from different angles.
• Magnetic resonance imaging is referred to as MRI: Abdominal magnetic resonance imaging (MRI) creates incredibly precise images of the organs and tissues that make up your urinary system by using radio waves and a magnetic field.

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Treatment Of Ureteral Obstruction

The goal of ureteral obstruction treatment is to either clear the obstruction or avoid it altogether, which may help restore kidney damage. Antibiotics might be part of the treatment to get rid of infections that are connected.

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Techniques for drainage

If a ureteral obstruction is causing excruciating agony, you may need an urgent operation to remove the obstruction's urine from your body and temporarily alleviate the problems it has brought. Your urologist may suggest:

To keep the ureter open, a hollow tube known as a ureteral stent is inserted inside of it.

Percutaneous nephrostomy, in which a catheter is inserted through your back by your doctor to drain your kidneys directly.

A catheter, or tube inserted into the urethra, is used to link an external drainage bag to the bladder. This may be especially important if you also have problems with your bladder that cause insufficient renal discharge.

Your doctor can advise you on the best procedure to do alone or in combination. The comfort that drainage techniques provide might be either temporary or long-lasting, depending on your condition.

Surgical procedures

Surgical methods are used to address urinary obstructions. Your unique situation determines the type of procedure you require.

The following surgical methods are used in urinary obstruction surgery:

• Endoscopic procedures: During this minimally invasive procedure, a lighted scope is inserted into the urethra, the bladder, and other urinary tract organs. The surgeon widens the damaged or obstructed segment of the ureter and inserts a hollow tube, called a stent, to keep the ureter open. Both diagnosing and treating an disease can be done with this method.
• Surgical incision: The surgeon makes an incision in your abdomen to remove the clog and repair your ureter.
• Laparoscopic techniques: By making one or more tiny skin incisions, the surgeon uses this technique to introduce a tiny tube that houses a light, a camera, and other necessary instruments for the procedure.
• Robotic support for laparoscopic surgeries: The surgeon uses a robotic instrument to do the laparoscopic surgery.

The main differences between different surgical techniques are the amount of time needed for recovery after surgery and the number and size of incisions created during the procedure. It is your urologist's decision what kind of procedure and surgical approach is best for treating your disease.

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