Obstructive uropathy is when your urine can’t flow (either partially or completely) through your ureter, bladder, or urethra due to some type of obstruction. Instead of flowing from your kidneys to your bladder, urine flows backward, or refluxes, into your kidneys.
The ureters are two tubes that carry urine from each of your kidneys to 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.
Causes of obstructive uropathy
Obstructive uropathy can occur due to a variety of factors. Compression can lead to damage to your kidneys and ureters.
Temporary or permanent blockages in your ureter or urethra, through which urine exits your body, can result from:
Injuries such as a pelvic fracture
Tumour mass that spreads to your kidneys, bladder, uterus, or colon
Diseases of the digestive tract
Kidney stones trapped in your 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 their bladder. However, pregnancy-induced uropathy is very rare.
Symptoms of obstructive uropathy
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 the 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 urine flows backwards into your organs.
A change in your urinary habits can indicate a blockage in your 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 your bladder isn’t empty
Decreased urine output
Blood in your 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.
Diagnosis of obstructive uropathy
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.
Treatment for obstructive uropathy
Removing the obstruction from blocked ureters is the main goal of treatment.
Surgery
A surgeon will remove masses such as cancerous tumours, polyps, or scar tissue that forms in and around your ureters. Once they clear the blockage from the affected ureter, urine can flow freely into your bladder.
Stent placement
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 your ureter or blocked area of your kidney. Stenting can be a solution for ureters that become narrower from scar tissue or other causes.
Your doctor will place a stent in your 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.
Long-term outlook
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 a person’s overall health
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