A partially obstructed ureter impedes urine flow from kidney to bladder, causing upstream dilation (hydronephrosis) and potential renal damage.
Common Causes
- Ureteral calculi (most common) – stone impacted but not completely blocking.
- Strictures – post‑surgical, post‑radiation, idiopathic, ischemic.
- Extrinsic compression: Retroperitoneal fibrosis, malignancies (cervical, colorectal, lymphoma), aortic aneurysm, endometriosis.
- Blood clots – post‑traumatic, post‑procedural, tumor bleeding.
- Tumors: Transitional cell carcinoma (primary), metastatic deposits.
- Congenital: UPJ obstruction, ureterovesical junction (UVJ) obstruction.
Symptoms
- Flank/colicky pain (may be intermittent).
- Dysuria, frequency, urgency.
- Hematuria (microscopic or gross).
- Nausea/vomiting (with severe pain).
- Fever/chills (if infected – obstructive pyelonephritis = emergency).
Diagnosis
- Urinalysis, urine culture, serum creatinine/eGFR.
- CT Urogram (gold standard): Stone, stricture, mass, hydronephrosis degree.
- Renal US (no radiation, good for hydronephrosis, poor for stones).
- MR Urography (pregnancy, contrast allergy).
- Retrograde pyelogram (during ureteroscopy).
Treatment
- Stones: MET (tamsulosin), SWL, ureteroscopy (URS) with laser lithotripsy.
- Strictures: Ureteral dilation, endoscopic incision, stent, ureteroureterostomy, ureteral reimplantation, buccal mucosal graft.
- Extrinsic: Treat primary (e.g., retroperitoneal fibrosis → steroids/tamoxifen; stent/nephrostomy for palliation).
- Tumors: Endoscopic resection, radical nephroureterectomy, systemic therapy.
- Stents/Nephrostomy: Temporary drainage for acute obstruction with infection or renal failure.
Prompt intervention preserves renal function and prevents sepsis.
