Ureteral Obstruction – Diagnosis and Treatment
Diagnosis
Doctors use several tools and methods to find out if someone has a blockage in the tube connecting the kidney and bladder. Blood and urine tests help spot kidney problems.
| Test Name | What It Shows |
|---|---|
| Urinalysis | Infection, blood, stones |
| Creatinine/BUN | Kidney function |
| Abdominal Ultrasound | Blockage, hydronephrosis |
| CT Scan | Detailed urinary tract images |
| MRI | Soft tissue and mass details |
| Cystoscopy | Inside bladder and urethra |
| Nuclear scan | Kidney drainage and function |
| Bladder Catheter | Urine flow and possible blockages |
High levels of creatinine or blood urea nitrogen (BUN) in the blood can mean the kidneys are not working well because of a blockage. A urinalysis may also show signs of infection or blood in the urine.
Imaging tests play a key role in diagnosis. An ultrasound can show swelling of the kidney (hydronephrosis) or the collection area of the kidney (renal pelvis) filling up with urine.
If more detail is needed, doctors may use a computed tomography (CT) scan, which makes cross-sectional images, or magnetic resonance imaging (MRI) for clear pictures of the urinary tract.
These tests can help spot kidney stones, tumors, or other masses causing urinary tract obstruction. A renal nuclear scan uses a small dose of radioactive tracer to highlight how well the kidneys and urinary system are working.
In cystoscopy, a doctor passes a small camera through the urethra to look inside the bladder and check for strictures or blockages. Sometimes, a doctor inserts a catheter to test if urine can flow freely from the bladder.
Doctors also consider other causes, such as benign prostatic hyperplasia (BPH), blood clots, or urethral stricture. When they suspect urolithiasis, or kidney stones, imaging can help find stones in the ureter or kidney.
If a patient has no urine output (anuria), severe kidney pain (renal colic), or signs of infection, doctors must diagnose quickly to prevent kidney damage.
Treatment
Methods to Remove Urine
When a blockage in the ureter causes pain or kidney issues, doctors focus on easing pressure and allowing urine to leave the body. They use several approaches:
| Technique | Description | Purpose |
|---|---|---|
| Ureteral Stent | Doctors place a small tube inside the ureter to keep it open. | Helps urine flow past the blockage. |
| Direct Kidney Drainage | Doctors insert a tube through the skin directly into the kidney to drain urine. | Bypasses the blocked ureter. |
| Bladder Catheterization | Doctors put a tube through the urethra to help drain urine from the bladder. | Useful when bladder drainage is poor. |
These methods can give short-term relief until a more lasting fix is possible. They may also be used as the main treatment if surgery is not an option.
Sometimes, doctors give pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs), especially if stone passage is possible. If infection is present, they prescribe antibiotics to control bacteria.
Surgical Options to Fix Blockage
If draining urine is not enough, doctors may perform surgery. The type of operation depends on the cause, the size of any stones, and the patient’s overall health. Some main options include:
Using an Endoscope: Doctors pass a thin, flexible camera through the urinary tract. They can make a small cut to clear the blockage and may leave a stent in place to keep the ureter open. Sometimes, they break and remove stones during the same procedure. This method is less invasive and often leads to a faster recovery.
Open Surgery: The surgeon makes a cut in the belly to reach the ureter, removes the cause of blockage such as a large stone or scar tissue, and repairs the ureter. Doctors may choose this approach if the blockage is difficult to reach or very large.
Laparoscopic and Robotic Procedures: For some patients, doctors make smaller cuts in the skin and use tiny tools and cameras to reach and fix the problem. Robot-assisted surgery allows even greater control. These methods generally lead to less pain and quicker healing.
The doctor will choose the method that best matches the patient’s needs. Pain control and follow-up care remain important parts of treatment. Doctors may use imaging, like pyelography, before or after surgery to check the ureter and kidneys.
Getting Ready for Your Visit
Steps You Can Take Beforehand
To make the most of your appointment, you can take several actions before you arrive:
- Check for Special Instructions: Call the clinic and ask if you need to prepare for any tests, such as not eating or drinking for a certain amount of time.
- Write Down Your Symptoms: Make a list that includes all symptoms, even ones that may not seem connected. Record when each symptom started and note if anything makes them better or worse.
- Gather Health Details: List important personal information, such as recent stresses, life changes, and any family health history, especially regarding kidney or urinary problems.
- List Your Medications: Include all medicines, vitamins, and herbal supplements you use, and their doses.
- Prepare Questions: Jot down questions to ask, such as the likely cause of your symptoms, possible treatments, and whether you’ll need to see a specialist.
Bringing a family member or friend to your visit can help. They can remind you of important points and help remember the advice you get.
Example questions to ask:
| Question |
|---|
| What might be causing my symptoms? |
| Are there other possible causes? |
| What tests will I need? |
| Could this be short-term or long-term? |
| What are the treatment options and risks? |
| Are there any lifestyle steps I should follow? |
| Should I see a specialist? |
Questions You Might Hear From Your Provider
Your health care provider will likely ask about your symptoms. Being ready to answer helps them understand your situation better.
Common questions include:
- When did you first notice your symptoms?
- Are the symptoms constant, or do they come and go?
- How severe are your symptoms?
- Has anything made them better or worse?
- Have you changed your fluid intake or diet recently?
Having this information ready can help your provider find the cause and plan the next steps.
How to Take Care of Yourself While Waiting
Before your visit, avoid anything that could make your symptoms worse. If any activity or food makes you feel more uncomfortable, avoid it. Drink water regularly unless your provider tells you not to.
Stay aware of how you feel, and write down any new symptoms you notice. This information can help during your appointment.
