The excretory system produces urine in the kidneys, which is stored in the urinary bladder until it is expelled out of the body. The urine is carried to the urinary bladder through a muscular tube called the ureter.

Each kidney is connected to one ureter. A blockage in one or both the ureters is known as a Ureteral obstruction.

The blockage prevents the urine flow from the kidneys into the urinary bladder. In the early stages, it causes mild pain fever. If left untreated, the blockage could lead to infection, sepsis, and death. The accumulation of too much urine in the kidney could also lead to kidney failure.

Ureteral Obstruction can be congenital or caused by external (intrinsic or extrinsic) factors.

• ● Genetic factors: The obstruction could be present at the time of birth in the following conditions.

1. Presence of two ureters: A condition in which one kidney has two ureters. The second ureter could be normal or partially developed. If one of the tubes doesn’t function properly, it could lead to an obstruction.
2. An abnormality at the connecting point: The connecting junction could show some abnormalities leading to an obstruction. This, in turn, could cause the kidneys to swell. This abnormality could be congenital or caused by an injury.
3. Ureterocele: In some cases, the ureter could be too narrow, obstructing the normal flow of urine. This could cause the ureter to bulge, thus leading to an obstruction.

• Other causes: The causes could be intrinsic(within the ureter) or extrinsic (outside the ureter), leading to obstruction. These include:

1. Stones in the ureter
2. Retroperitoneal fibrosis: The fibres encircle the ureter and block the tube. The fibrosis could be due to some cancer or medications used to treat migraines
3. Severe constipation
4. Benign and malignant tumours
5. Endometriosis in females
6. Enlarged prostate glands in males

Symptoms depend on various conditions. Not all patients show signs and symptoms.

Symptoms depend on the blockage location, whether it is partial or complete, affecting one tube or both. Based on these factors, symptoms could be mild, moderate or severe.

• Individuals with a Ureteral obstruction could experience severe pain, making daily activities such as sitting and walking difficult. This pain could be accompanied by nausea, vomiting, fever, and chills
• Reduced urine output
• Difficulty urinating
• Blood in urine
• Urinary tract infections
• Hypertension

Congenital disorders are generally diagnosed in a routine prenatal ultrasound scan. If there is an issue in the kidney or the excretory organs and the doctor feels it is treatable, it may be re-evaluated after birth through another ultrasound.

In other cases, the following diagnostic tests are done to diagnose the condition:

• Routine urine and blood tests: The routine tests show the signs of infection and creatinine presence
• Ultrasound scan
• Voiding cystourethrogram: A small catheter is inserted into the bladder through the urethra, and a dye is injected. After this, an X-ray is taken before and after urination to assess the condition.
• Renal nuclear scan: A special dye that contains radioactive material is injected into your arms. Then images are taken to assess the urinary system
• Cystoscopy: A small tube with a camera and a light at the tip is inserted into your urethra to make an incision allowing the doctor to visualise the blockage and make a diagnosis
• Computerised tomography (CT) scans
• Magnetic resonance imaging (MRI): An MRI gives detailed imaging of the entire system, thus allowing an accurate diagnosis

The purpose of the treatment is to remove the obstruction or to bypass the blockage. Along with this, if an infection is present, a course of antibiotics should help. If you experience severe pain, then your doctor would first attempt to relieve your pain by draining the urine in one of the following ways:

• Ureteral stent: A hollow tube is inserted into the ureter to keep it open and allow urine to move out.
• Percutaneous nephrotomy: In this, the kidney is drained directly from your back, inserting a tube.
• Catheter: A tube is inserted into the bladder through the urethra and is connected to a drainage bag externally.

Based on your clinical condition, your doctor would be able to take a call as to which procedure will work best for you.

Next, the obstruction has to be removed surgically. The type of surgery depends on your clinical condition.

1. Endoscopic surgery: A tube with a camera at its tip is inserted through the urethra into the bladder. The surgeon then removes the damaged or blocked part of the ureter. This can be done both as a diagnostic tool as well as a treatment for ureter obstructions.
2. Open surgery: An incision is made in your abdomen, and the blockage is surgically removed.
3. Laparoscopic surgery: A minimally invasive technique in which one or more openings are made on the skin and a tube is inserted, and the blockage is removed.
4. Robot-assisted laparoscopic surgery: A robotic system is used along with laparoscopic techniques.

Most people get back to normal in 7 to 10 days. Healing is much faster and uneventful in the case of laparoscopic and robotic-assisted surgery. Ninety-seven per cent of cases recover and never report any recurrence.

As with any surgery, it has a few risks, including:

• Infection
• Bleeding
• Pain
• Problems related to anaesthesia
• Urine leakage