Ureteral Obstruction: Causes, Symptoms, And Treatment
Ureteral obstruction (a.k.a: Hydronephrosis) happens when there is a blockage in the urinary tract, which obstructs the outflow of urine. The ureter may be blocked due to some acute and chronic kidney conditions. The blockage in the ureter may be present since birth or can be developed due to the scarring from cancer treatment, kidney stones or certain other conditions. Ureteral obstruction may result in the backflow of urine, which can cause long-term damage to the kidneys.
What is Ureteral Obstruction?
Ureteral obstruction occurs due to the blockage in the ureter that obstructs the flow of urine through the urinary tract. It is a common condition caused by an acute injury. Ureteral obstruction can affect the people of any age group. Ureteral obstruction can result in bladder dilation.
What are the Causes of Ureteral Obstruction ?
Ureteral obstruction occurs due to various internal and external conditions that affect the urine outflow. Most of the time, blockage occurs due to scarring, kidney stones, and blood clots. The following are the possible causes of ureteral obstruction:
Improper connection of the ureter to the bladder or the kidney: Any abnormality at the ureteropelvic junction (a connection between the ureter and kidney) can be an obstruction to the urine outflow. This can be a congenital defect or can be developed in due course of life due to scarring or tumor.
Duplication of the ureter: This is the most common congenital condition that causes ureteral obstruction. In this condition, two ureters form on the same kidney, where one of the ureters may be partially developed.
Tumors: Most of the malignant tumors that are developed within the ureter, especially transitional cell carcinomas can cause ureteral obstruction.
Blood clots: Bleeding due to tumors, blood clots, or papillary necrosis may form an obstruction in the ureter. This condition is mostly seen in the people suffering with massive hematuria.
Ureterocele: When the ureter is too narrow, it develops a tiny bulge in the ureter known as ureterocele. This causes blockage in the section of the ureter and impedes urine outflow.
Kidney stones: When the formed kidney stones cannot pass through the ureter, they obstruct the urine outflow.
Swelling of the ureteral wall: A severe swelling of the ureteral wall due to schistosomiasis (a parasite infection) or tuberculosis can lead to ureteral obstruction.
Symptoms of Ureteral Obstruction:
Sometimes, the ureteral obstruction may not show any signs and symptoms, as it may depend upon the underlying cause of the obstruction. The following are the symptoms that indicate ureteral obstruction:
- Difficulty in passing urine
- Pain while urinating
- Trouble in starting the urine stream
- Abdominal pain
- Frequent UTIs (urinary tract infections)
- Decreased urine output
- Blood in urine
Risk factors of Ureteral Obstruction:
The following are the factors that increase the risk of developing ureteral obstruction:
- An enlarged prostate can increase the risk of developing ureteral obstruction
- Scarring in the urinary tract can increase the risk of ureteral obstruction
- Individuals with an injury or trauma in the pelvic region are more prone to acquire the condition
- People with specific nervous system disorders are at risk of developing ureteral obstruction
- Digestive tract diseases can develop a risk of blockages in the ureter
- Severe constipation can increase the risk of ureteral obstruction in children
Complications of Ureteral Obstruction:
If an obstruction in the ureter is left untreated, it can increase the risk of sepsis, urinary tract infection (UTI), and formation of kidney stones. Ureteral obstruction decreases the renal function, which can lead to complications like glomerular hyalinization, renal tubular atrophy, and fibrosis.
Untreated ureteral obstruction can result in backflow of urine into the kidney, which may cause infection or damage to the kidneys. In severe cases, the ureteral obstruction can lead to bladder dysfunction, fistula formation, and loss of kidney function.
Diagnosis of Ureteral Obstruction:
To begin the diagnosis of ureteral obstruction, the doctor would initially make an overall assessment of the health status. The doctor would then palpate near the abdominal area to look for any signs of pain. If the doctor suspects an obstruction in the ureter, he would recommend the following tests:
Blood and Urine Tests: The doctor would collect a sample of blood and urine to determine the presence of creatinine. Presence of creatinine in the blood and urine sample indicates the signs of infection.
Imaging Tests: The doctor recommend imaging procedures, such as an ultrasound scan, magnetic resonance imaging (MRI), and computerized tomography (CT) scan to view the internal organs. CT scan and MRI produce detailed cross-sectional images of the kidneys, ureter, and bladder.
Cystoscopy: The procedure involves the insertion of a small tube-like device attached to a tiny camera into the urethra or an incision. This helps the doctor to view the inside of the urethra and bladder.
Voiding Cystourethrogram: This is a urine flow test, in which the doctor inserts a catheter through the urethra and takes X-rays of bladder and urethra.
Renal Nuclear Scan: In this procedure, the doctor injects a dye with the radioactive material into the arm. This radioactivity produces images and helps to assess the urinary system.
Treatment of Ureteral Obstruction:
The treatment aims to remove the obstacles that are blocking the outflow of urine. Based on the underlying cause of the condition, the doctor would recommend one of the following treatment options:
Insertion of Catheter: The doctor would insert a catheter into the bladder to drain the urine completely.
A Ureteral Stent: The doctor would place a hollow, tube-shaped device inside the ureter to allow the easy passage of the urine.
Percutaneous Nephrostomy: In this procedure, the doctor would insert a small, flexible, tube-like structure known as a catheter through the back to drain the kidney.
Surgery: Surgical procedures can remove a ureteral obstruction. The doctor would recommend a minimally invasive endoscopic or laparoscopic surgery, where the damaged or blocked part of the ureter can be treated.
Prevention of Ureteral Obstruction:
Most of the time, kidney stones are the underlying cause of ureteral obstruction. Drinking plenty amount of water can reduce the formation of kidney stones, which contribute to the ureteral obstruction. Having a check on the intake of oxalate-rich foods prevents the formation of calcium oxalate stones.