Ureteral Obstruction

What is ureteral obstruction?

A ureteral obstruction is a blockage in one or both of your ureters. Ureters are the tubes that carry pee from your kidneys to your bladder. Many different conditions and diseases can cause a blockage in your ureters.

A ureteral obstruction prevents pee from moving into your bladder and out of your body. Without treating and removing the blockage, pee can back up and damage your kidneys. This can cause pain and put you at risk of infection. In severe cases, a ureteral obstruction can lead to kidney failure, sepsis (life-threatening infection) or death. This is rare, though, because healthcare providers can treat ureteral blockages.

How common is ureteral obstruction?

Ureteral obstructions are fairly common. They’re more common in men and people assigned male at birth (AMAB) over 60 because their prostates enlarge as they age. A prostate is a gland that sits below your bladder in front of your rectum. An enlarged prostate can block the flow of pee and result in buildup of pee in your bladder. It can also push up against your ureter and cause a blockage. Any person at any age can have a blocked ureter, including children.

What are the symptoms of ureteral obstruction?

Signs of ureteral obstruction reveal themselves in different ways. People who have kidney stones obstructing a ureter may have severe pain. When the blockage is gradual and slow, it usually comes on slowly and builds over time. In some cases, symptoms may be mild at first, but can quickly get worse. Symptoms of a blocked ureter or urinary tract obstruction include:

• Pain in your abdomen, lower back or sides below your ribs (flank pain).
• Fever, nausea or vomiting.
• Difficulty urinating or emptying your bladder.
• Frequent urination.
• Recurring urinary tract infections (UTIs).
• Pee that’s bloody or cloudy.
• Swollen leg(s).

What causes ureteral obstruction?

There are many different reasons why your ureter can become blocked. Causes of a ureteral obstruction include:

• Enlarged prostate, a condition called benign prostatic hyperplasia (BPH).
• Scar tissue in your ureter, which can make it hard for pee to pass through. You can develop it or be born with it (congenital).
• Tumors or cysts in your abdominal area that press on your ureter.
• Vascular (blood vessel) disease and blood clots.
• Gastrointestinal (GI) issues, such as Crohn’s disease, diverticulitis or a swollen appendix.
• Ureteral stones, which are kidney stones that move to your ureter.
• Ureteropelvic junction obstruction, which is a blockage of your ureter at its connection to your kidney.
• Ectopic ureter, when your ureter connects to the wrong place in your body.
• Ureterocele, a birth condition that causes swelling in your ureter.
• Pregnancy, endometriosis or uterine prolapse.

What are complications of a blocked ureter?

When pee can’t leave your body and starts to build up in your kidneys, it can lead to hydronephrosis (swelling of the kidneys). If left untreated, obstruction of your ureter can cause serious problems.

It’s important to note that kidney damage is hard to reverse. This means once your kidneys show signs of damage, your provider can’t make them 100% healthy. You can only manage any kidney damage and stop it from progressing.

How is it diagnosed?

If you suspect you have ureteral obstruction, you should see your healthcare provider. Some of the signs of a blocked ureter are like symptoms of other conditions that need treatment, such as urinary tract infections, having abdominal pain or not being able to pee even when you drink plenty of fluids.

Your provider may also order tests to help them make a diagnosis. These tests could include:

• Blood tests and urinalysis: These tests can tell your provider how well your kidneys are working or if there’s an infection.
• Ultrasound: An ultrasound can give your provider a better view of your kidneys, bladder and ureters.
• CT (computed tomography) scan.
• Bladder scan or post-void residual: This is a specific type of test that can check to see if you’re emptying your bladder completely.

How do you treat a ureteral obstruction?

The treatment you receive depends on the reason for the blockage. First, your healthcare provider will perform a procedure to allow the pee to drain from your body. These procedures include:

• Inserting a ureteral stent: Healthcare providers insert a thin tube in your ureter that holds the ureter open so pee can drain freely.
• Nephrostomy tube: In this procedure, your provider creates an opening in the skin near your kidney. They insert a catheter into the opening and drain pee directly from your kidney.
• Placing a catheter in your bladder: This is a procedure that involves inserting a catheter through your urethra and into your bladder to drain your pee. This is helpful when the blockage affects your bladder as well as your ureters.

After draining the pee, your provider will address the reason for the blockage. What happens next will depend on what caused the obstruction and the severity of the blockage.

Common treatments for ureteral obstruction are:

• Medication: If an enlarged prostate is causing the blockage, doctors may prescribe an alpha-blocker to relax your prostate muscles. A medicine called finasteride (Proscar®) can shrink your prostate.
• Surgery: There are several different surgical methods to treat a ureteral blockage from minimally invasive office procedures to open abdominal surgery. Your healthcare provider will decide what type of surgery is necessary based on your situation. With each type, your surgeon removes the blockage and repairs your ureter.

What are the side effects of the treatment for ureteral obstruction?

The side effects of alpha-blockers include dizziness, headaches and fainting. Side effects of finasteride (Proscar), the medication used to shrink your prostate, include decreased sexual desire and increased hair growth.

Surgery to remove the obstruction can have side effects such as discomfort and increased risk of infection. Each type of surgery carries its own risks. Your healthcare provider can discuss the risks of each type of surgery with you.

How can you prevent ureteral obstruction?

There isn’t anything you can do to prevent ureteral obstruction, especially when the cause is congenital (something that’s there at birth). Sometimes, managing other conditions can decrease your risk of a ureteral obstruction.

You can take steps to avoid developing a ureteral stone, which happens when a kidney stone moves to your ureter. Some steps to lower your risk for kidney stones are:

• Drink plenty of water.
• Maintain a weight that’s healthy for you.
• Limit your sodium (salt) intake.
• Get approximately 1,000 to 1,200 mg (milligrams) of calcium per day.

What can I expect if I have this condition?

The outlook for ureteral obstruction depends on whether your kidneys were damaged while pee was unable to drain. If your healthcare provider fixes the blockage before serious kidney damage occurs, ureteral obstruction doesn’t usually have serious long-term effects. In severe cases, an untreated ureteral obstruction can cause kidney failure and death.

When should I see my healthcare provider?

If you have signs of ureteral obstruction, you should call your healthcare provider right away. Symptoms may be mild at first but can get worse quickly and be very serious.

Can you still pee with a blocked ureter?

Yes, you may still be able to pee with a blocked ureter. It depends on how severe the blockage is.

A note from Cleveland Clinic

It’s important for pee to leave your body because it’s a type of waste. If it doesn’t, it can back up into your kidneys and cause damage or infection. Contact a healthcare provider if you notice any changes in how you pee, especially if it’s accompanied by pain. The good news is, there are many ways to treat ureter obstruction based on the severity of the blockage. Be sure to ask your provider any questions you have about your treatment.