Diagnosis

Often, doctors diagnose ureteral obstruction disorders before birth during routine prenatal ultrasounds, which can show details of the developing fetus, including the kidneys, ureters and bladder. Doctors often perform another ultrasound after birth to re-evaluate the kidneys.

If your doctor suspects you have an obstructed ureter, some of these tests and scans might be used to reach a diagnosis:

  • Blood and urine tests. Your doctor checks samples of your blood and urine for signs of infection and the presence of creatinine, which signals that your kidneys aren't working properly.
  • Ultrasound. An ultrasound of the area behind your abdominal organs (retroperitoneal ultrasound) allows your doctor to view the kidneys and ureters.
  • Voiding cystourethrogram. To test for abnormal urine flow, your doctor inserts a small tube (catheter) through the urethra, injects dye into your bladder, and takes X-rays of your kidneys, ureters, bladder and urethra before and during urination.
  • Renal nuclear scan. Similar to an IVP, your doctor or a technician injects dye that contains a small amount of radioactive material into your arm. A special camera detects the radioactivity and produces images that your doctor uses to evaluate the urinary system.
  • Cystoscopy. A small tube with a camera and light is inserted into your urethra or through a small incision. The optical system allows the doctor to see inside the urethra and bladder.
  • Computerized tomography (CT) scan. A CT scan combines a series of X-ray views taken from many different angles and computer processing to create cross-sectional images of your kidneys, ureter and bladder.
  • Magnetic resonance imaging (MRI). An abdominal MRI uses a magnetic field and radio waves to create detailed images of the organs and tissues that make up your urinary system.

Treatment

The goal of ureteral obstruction treatment is to remove blockages, if possible, or bypass the blockage, which may help repair damage to the kidneys. Treatment might include antibiotics to clear associated infections.

Drainage procedures

A ureteral obstruction that causes severe pain might require an immediate procedure to remove urine from your body and temporarily relieve the problems caused by a blockage. Your doctor (urologist) may recommend:

  • A ureteral stent, a hollow tube inserted inside the ureter to keep it open.
  • Percutaneous nephrostomy, during which your doctor inserts a tube through your back to drain the kidney directly.
  • A catheter, a tube inserted through the urethra to connect the bladder to an external drainage bag. This may be especially important if problems with your bladder also contribute to poor drainage of your kidneys.

Your doctor can tell you which procedure or combination of procedures is best for you. Drainage procedures might provide temporary or permanent relief, depending on your condition.

Surgical procedures

There are a number of surgical procedures used to correct ureteral obstructions. The type of procedure depends on your situation.

Ureteral obstruction surgery may be performed through one of these surgical approaches:

  • Endoscopic surgery, a minimally invasive procedure, which involves passing a lighted scope through the urethra into the bladder and other parts of the urinary tract. The surgeon makes a cut into the damaged or blocked part of the ureter to widen the area and then places a hollow tube (stent) in the ureter to keep it open. This procedure may be done to both diagnose and treat a condition.
  • Open surgery, during which your surgeon makes an incision in your abdomen to perform the procedure.
  • Laparoscopic surgery, which is performed through a small tube with a light and a camera that allows your surgeon to see inside you. The surgeon makes one or more small incisions through your skin to insert the lighted tube and other instruments needed for the procedure.
  • Robot-assisted laparoscopic surgery, during which your surgeon uses a robotic system to perform a laparoscopic procedure. 

The main differences among these surgical approaches are your recovery time after surgery and the number and size of incisions used for the procedure. Your doctor (urologist) determines the type of procedure and the best surgical approach to treat your condition.

Preparing for your appointment

You might start by seeing your primary care provider. Or, you might be referred immediately to a urinary tract specialist (urologist).

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:

  • Your symptoms, including any that seem unrelated to the reason for your appointment
  • Key personal information, including major stresses, recent life changes and family medical history
  • All medications, vitamins or other supplements you take, including the doses
  • Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you're given.

For ureteral obstruction, basic questions to ask your doctor include:

  • What's likely causing my symptoms?
  • Other than the most likely cause, what are other possible causes for my symptoms?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What's the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have these other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • Are there brochures or other printed material I can have? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you several questions, such as:

  • When did your symptoms begin?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

Ureteral obstruction care at Mayo Clinic

Nov. 17, 2017
References
  1. Zeidel ML, et al. Clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis. http://www.uptodate.com/home. Accessed July 13, 2016.
  2. Skorecki K, et al, eds. Kidneys & urinary system. In: Brenner & Rector's The Kidney. 10th ed. Philadelphia, Pa.: Elsevier; 2016. http://www.clinicalkey.com. Accessed July 13, 2016.
  3. Obstructive uropathy. Merck Manual Professional Version. http://www.merckmanuals.com/professional/genitourinary-disorders/obstructive-uropathy/obstructive-uropathy. Accessed July 13, 2016.
  4. Goldman L, et al., eds. Obstructive uropathy. In: Goldman-Cecil Medicine. 25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed July 13, 2016.