Obstructive Uropathy

Obstructive uropathy is a condition in which your urine flow reverses direction. Instead of flowing from the kidneys to the bladder, the urine “refluxes” back into the kidneys. Reflux literally means “a flowing back of a liquid.”

The urine reflux in obstructive uropathy is due to a blockage in a ureter, one of the tubes that carries urine between the two organs. 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. In fact, it can also be a problem for an unborn child during pregnancy.

Obstructive uropathy can be caused by a variety of factors. Compression to the kidneys in the abdominal cavity is one of the leading causes of obstructive uropathy (Merck Manuals, 2007). Compression can lead to damage in your kidneys and the ureters that carry urine to the bladder.

Temporary or permanent blockages in the ureter can result from:

• injuries such as a pelvic fracture
• cancer that spreads to your kidneys, bladder, uterus, or colon
• digestive tract diseases
• kidney stones
• blood clots

Nervous system disorders can also cause obstructive uropathy. This occurs when the nerves responsible for bladder control do not function properly. The use of neurogenic drugs to control an overactive bladder can also cause obstructive uropathy in some cases.

An enlarged prostate can lead to 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 will feel pain in your midsection, on one or both sides of your body. The level and location of pain varies in each person, and especially 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 backwards 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
• the feeling that the bladder is not empty
• decreased urine output
• blood in the urine

You may not show a decrease in the amount of urine you expel if just one kidney is blocked. Usually both kidneys need to be dysfunctional 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 lower-than-normal level of amniotic fluids in the womb. Urine is one of the components of amniotic fluid. A fetus with obstructive uropathy is unable to urinate outside their body. Thus, the amniotic fluid volume drops.

Your doctor will diagnose obstructive uropathy with ultrasound technology. Scans of the pelvic region and the kidneys will show if urine is backing up into the kidneys. Imaging tools can also point out blockages to your doctor.

Removing the obstruction from the blocked ureters is the main goal of treatment.

Surgery

Masses such as cancerous tumors, polyps, or scar tissue that forms in and around the ureters must be removed surgically. Once the blockage is cleared away from the affected ureter, urine can flow freely into the 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 the ureter or area of the kidney that is blocked. Stenting can be a solution for ureters that become narrower from scar tissue or other causes. Stents are delivered to the ureter with a flexible tube called a catheter. Catheterization is typically performed with the use of numbing medication while you are awake. In some cases you may be sedated for the procedure.

Treatment for Unborn Children

Fetal obstruction may be treated 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 appeared to be irreversibly damaged (University of Michigan). Most often, kidney function and blocked ureters are repaired after the baby is born.

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 individual’s overall health.