- Obstructive uropathy is when something partially or completely blocks urine from flowing through the ureter.
- Common causes include kidney stones, nervous system disorders, enlarged prostate in men, and injuries such as a pelvic fracture.
- Treatments include surgery or stents. Unborn children with obstructive uropathy may receive a shunt (drainage system).
Obstructive uropathy is when your urine cannot flow (either partially or completely) through the ureter due to some type of obstruction. Instead of flowing from the kidneys to the bladder, the urine flows backward, or refluxes, into the kidneys.
A ureter is one of the tubes that carries urine between your kidney and your bladder. Obstructive uropathy can cause swelling and other damage to one or both of your kidneys.
This condition can affect men and women of any age. It can also be a problem for an unborn child during pregnancy.
Obstructive uropathy can be due to a variety of factors. Compression can lead to damage to your kidneys and the ureters that carry urine to your bladder.
Temporary or permanent blockages in your ureter can result from:
- injuries such as a pelvic fracture
- tumor mass that spreads to your kidneys, bladder, uterus, or colon
- diseases of the digestive tract
- kidney stones trapped in the ureter
- blood clots
Nervous system disorders can also cause obstructive uropathy. This occurs when the nerves responsible for bladder control don’t function properly. The use of neurogenic drugs to control an overactive bladder can also cause obstructive uropathy in some cases.
An enlarged prostate is a frequent cause of obstructive uropathy in men. Pregnant women may also experience a reversed urine flow due to the additional weight of the fetus pressing down on the bladder. However, pregnancy-induced uropathy is very rare.
The onset of obstructive uropathy can be very quick and acute, or slow and progressive. You’ll feel pain in your midsection on one or both sides of your body. The level and location of pain varies from person-to-person and depends on whether one or both kidneys are involved. Fever, nausea, and vomiting are also common symptoms of obstructive uropathy. You may experience swelling or tenderness in the kidneys as the urine flows backward into the organs.
A change in your urinary habits can indicate a blockage in the ureters. Symptoms to look for include:
- difficulty passing urine
- a slowed stream, sometimes described as a “dribble”
- a frequent urge to urinate, especially at night (nocturia)
- the feeling that the bladder is not empty
- decreased urine output
- blood in the urine
You may have a decrease in the amount of urine you expel if just one of your kidneys is blocked. Usually, both kidneys need to be blocked to impact urine output.
Symptoms in Unborn Children
Obstructive uropathy can be a problem in an unborn fetus. One of the signs of obstruction in an unborn baby is a level of amniotic fluids in the womb that’s lower than normal. Urine is one of the components of amniotic fluid. A fetus with obstructive uropathy is unable to urinate outside their body. This leads to a drop in amniotic fluid volume, which can lead to fetal or birthing complications.
Your doctor will diagnose obstructive uropathy with an ultrasound. Scans of your pelvic region and your kidneys will show if urine is backing up into your kidneys. Imaging tools can also point out blockages to your doctor.
Removing the obstruction from the blocked ureters is the main goal of treatment.
A surgeon will remove masses such as cancerous tumors, polyps, or scar tissue that forms in and around the ureters. Once they clear the blockage from the affected ureter, urine can flow freely into the bladder.
A less intrusive form of treatment is the placement of a stent in the blocked ureter or kidney. A stent is a mesh tube that opens up inside the ureter or blocked area of the kidney. Stenting can be a solution for ureters that become narrower from scar tissue or other causes. Your doctor will place a stent in the ureter with a flexible tube called a catheter. Catheterization is typically performed with the use of numbing medication while you’re awake. In some cases, you may be sedated for the procedure.
Treatment for Unborn Children
Your doctor may be able to treat fetal obstruction in the womb in some cases. Your doctor may place a shunt, or drainage system, in your unborn baby’s bladder. The shunt will drain urine into the amniotic sac. Fetal treatment is usually performed only when the baby’s kidneys appear to be irreversibly damaged. Most often, doctors can repair kidney function and blocked ureters after the baby is born.
The outlook for obstructive uropathy depends on whether one or both kidneys are affected. People who have an obstruction in only one kidney are less likely to encounter chronic uropathy. Those with recurring obstructions in one or both kidneys are more likely to experience extensive kidney damage. Kidney damage may be reversible or can remain unchanged based on each person’s overall health.
Treatment and recovery times often depend on the cause of the uropathy. Short-term treatment options include stents or drains. These are placed in the ureter to relieve the blockage until a more permanent treatment is performed. Sometimes, nephrostomy tubes can help drain urine from the kidneys through the back. Other times, a Foley catheter is placed through the urethra to empty urine from the bladder. A catheter is often used in people with an enlarged prostate or nervous system disorder.
In chronic conditions, surgery may ultimately be needed to repair the damaged urinary system.