Ureteral Obstruction

Diagnosis

Ureteral obstruction disorders are often diagnosed before birth during routine prenatal ultrasounds, which can show details of the developing fetus, including the kidneys, ureters, and bladder. After birth, another ultrasound may be performed to reevaluate the kidneys.

If a ureteral obstruction is suspected, several tests and scans may be used to confirm the diagnosis:

• Blood and urine tests: These tests check for signs of infection and measure creatinine levels, which can indicate how well the kidneys are functioning.

• Ultrasound: A retroperitoneal ultrasound provides images of the kidneys and ureters to detect blockages or abnormalities.

• Bladder catheterization: A small tube (catheter) is inserted through the urethra, and dye is injected into the bladder. X-rays are then taken before and during urination to assess urine flow.

• Renal nuclear scan: A small amount of radioactive tracer is injected into the arm, and a special camera captures images to evaluate kidney function and urine drainage.

• Cystoscopy: A small tube with a light and camera is inserted into the urethra or through a small incision to view the inside of the bladder and urethra.

• Computerized tomography (CT) scan: A CT scan creates detailed cross-sectional images of the kidneys, ureters, and bladder to locate blockages or abnormalities.

• Magnetic resonance imaging (MRI): An abdominal MRI uses magnetic fields and radio waves to create detailed images of the urinary system’s organs and tissues.

Treatment

The goal of ureteral obstruction treatment is to remove or bypass the blockage to restore normal urine flow and protect kidney function. Treatment may also include antibiotics to treat any associated infections.

Drainage procedures
If the obstruction causes severe pain or kidney damage, immediate drainage procedures may be required to relieve pressure and improve urine flow. Options include:

• Ureteral stent: A hollow tube inserted inside the ureter to keep it open.

• Percutaneous nephrostomy: A tube inserted through the back directly into the kidney to drain urine.

• Catheterization: A tube inserted through the urethra to connect the bladder to an external drainage bag, especially useful when bladder issues also affect urine flow.

These procedures may provide temporary or permanent relief depending on the cause and severity of the obstruction.

Surgical procedures
Several surgical options are available to correct ureteral obstructions, and the choice depends on the specific condition and overall health of the patient.

• Endoscopic surgery: A minimally invasive procedure using a lighted scope passed through the urethra to reach the ureter. The surgeon cuts the narrowed section and places a stent to keep it open.

• Open surgery: A traditional approach involving an abdominal incision to remove the blockage and repair the ureter.

• Laparoscopic surgery: Small incisions are made to insert instruments and a camera to perform the repair.

• Robot-assisted laparoscopic surgery: The surgeon uses a robotic system for greater precision and control during the laparoscopic procedure.

The main differences between these surgical methods include recovery time, incision size, and the level of invasiveness. The urologist will determine the most suitable approach based on the patient’s condition and treatment goals.