ureteral disease

Ureteral Disease: Causes, Symptoms, and Treatment

The ureters are two narrow tubes that connect the kidneys to the bladder, playing a crucial role in removing waste from the body. However, various conditions can affect these tubes, leading to ureteral diseases.

Causes of Ureteral Diseases

• Kidney stones: Also known as ureterolithiasis, this condition occurs when a stone or stones form in the ureters, causing blockages and pain [8].
• Ureteral obstruction: A blockage in the ureters can prevent pee from moving into the bladder, leading to kidney damage and potentially life-threatening complications [2].
• Stricture: A narrowing of the ureter due to scar tissue or other conditions can cause urine to back up and lead to kidney damage [4].
• Cancer: Ureteral cancer is a rare but serious condition where abnormal cells grow in the ureters, affecting their function [6].

Symptoms of Ureteral Diseases

• Pain: Severe pain in the abdomen or flank area can be a symptom of various ureteral diseases [5].
• Blood in urine: Hematuria is a common symptom of many ureteral conditions, including kidney stones and cancer [5].
• Fever: Infection or inflammation in the urinary tract can cause fever.
• Reduced urine output: A blockage in the ureters can lead to reduced urine production.

Treatment Options

• Medications: Treatment for ureteral diseases often involves medications to manage pain, infection, and other symptoms [1].
• Surgery: In severe cases, surgery may be necessary to remove stones or repair damaged tissue.
• Stents: A hollow tube called a stent can be inserted into the ureters to keep them open and prevent further blockages.

Prevention

While some causes of ureteral diseases are unavoidable, certain conditions present at birth or kidney stones can increase the risk of developing these conditions. Maintaining good urinary tract health through regular check-ups and addressing any symptoms promptly can help prevent complications.

References: [1] NIH: National Institute of Diabetes and Digestive and Kidney Diseases [2] [4] [5] [6] [8] [11] [12] [13] [14] [15]

Common Signs and Symptoms of Ureteral Disease

Ureteral disease can manifest in various ways, depending on the severity and location of the obstruction or stricture. Here are some common signs and symptoms:

• Pain: Severe flank pain and back pain are common complaints among individuals with ureteral obstruction or stricture ([4], [11]). The pain may be intermittent and worsen with increased fluid intake ([9]).
• Blood in Urine: Blood in the urine, which can make it appear red, pink, or cola-colored, is a symptom of ureteral disease ([5], [6], [12]).
• Urinary Tract Infections (UTIs): Frequent UTIs and pus or blood in the urine are also symptoms of ureteral stricture ([9], [12]).
• Nausea and Vomiting: Pain accompanied by nausea and vomiting, fever or chills is a symptom of ureteral disease ([6], [13]).
• Weight Loss: Unintentional weight loss can occur due to the underlying cause of the ureteral obstruction or stricture ([5]).
• Abdominal Swelling: Long-term swelling of the ureter wall, usually due to diseases such as tuberculosis or a parasite infection called schistosomiasis, can lead to abdominal swelling ([1], [8]).

Other Possible Symptoms

In some cases, individuals with ureteral disease may experience:

• Drowsiness and Decreased Alertness: In severe cases, drowsiness and decreased alertness, including coma, can occur due to the obstruction or stricture ([4]).
• Kidney Stones: Kidney stones can cause severe pain, nausea, vomiting, fever, chills, and blood in the urine ([13]).

Important Note

Ignoring these signs and symptoms could lead to complications and further damage to your kidneys and urinary tract. If you are experiencing any of these symptoms, it is essential to seek medical attention promptly.

Diagnosing Ureteral Disease: A Comprehensive Overview

Ureteral disease can be a complex and challenging condition to diagnose, but various tests and scans can help healthcare providers identify the underlying issue. Here's an overview of the diagnostic tests used to diagnose ureteral disease:

• Imaging Tests: Imaging tests such as pyelogram, cystography, CT scan or ultrasound of the kidney, prostate/rectal sonogram, and renal angiogram provide visibility into the urinary tract to look for blockages, tumors, and other abnormalities [2].
• Urine Collection and Blood Tests: Urine collection and blood tests are commonly used as the first steps in diagnosing and screening urologic conditions [2].
• Ureteroscopy: During a ureteroscopy, a urologist can treat problems such as urine blockage in a ureter, remove a stone from a ureter or kidney, remove or treat abnormal tissue and tumors, and take a sample of ureter or kidney tissue for a biopsy [5].
• Diagnostic Tests for Ureteral Stricture: People with a ureteral stricture may experience pain or a feeling of fullness in the side or abdomen. Blood in the urine and nausea are also symptoms of a ureteral stricture, as are frequent urinary tract infections. Diagnostic tests for a ureteral stricture include urinalysis, blood test, ultrasound, health history and physical exam [6][7].
• Other Tests: Other tests such as complete blood count (CBC), blood chemistry tests, and ureteroscopy and cystoscopy may also be used to diagnose ureteral disease.

It's essential to note that the specific diagnostic tests used will depend on the individual case and the suspected underlying condition. A healthcare provider will typically use a combination of these tests to reach an accurate diagnosis.

References:

[1] Diagnosis of ureteral obstruction disorders before birth during routine prenatal ultrasounds. [2] Urine collection and blood tests are commonly the first steps in diagnosing and screening urologic conditions. [3] Imaging tests make pictures of the body. They may help your healthcare team better understand the size of the cancer. [4] Imaging tests also can look for signs that cancer may have spread beyond the ureter. [5] During a ureteroscopy, a urologist can treat problems such as urine blockage in a ureter, remove a stone from a ureter or kidney, remove or treat abnormal tissue and tumors, and take a sample of ureter or kidney tissue for a biopsy. [6] People with a ureteral stricture may experience pain or a feeling of fullness in the side or abdomen. Blood in the urine and nausea are also symptoms of a ureteral stricture, as are frequent urinary tract infections. [7] Diagnostic tests for a ureteral stricture include urinalysis, blood test, ultrasound, health history and physical exam.

Treatment Options for Ureteral Disease

Ureteral disease can be treated using various methods, including medication and minimally invasive procedures.

• Alpha-blockers: These medications relax the muscles in the ureter, making it easier for stones to pass through. Tamsulosin (0.4 mg daily) and nifedipine (30 mg daily) are commonly prescribed alpha-blockers for patients with lower ureteral calculi [1][2].
• Pain relief: Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) can be used to relieve mild pain associated with ureteral disease [3].
• Medical expulsive therapy (MET): Alpha-blockers are sometimes used in combination with other medications to improve stone passage through MET. However, the effectiveness of this approach remains controversial [2].

Medications for Ureteral Obstruction

In cases where an enlarged prostate is causing ureteral obstruction, doctors may prescribe alpha-blockers to relax the muscles and facilitate stone passage. Nifedipine has also been shown to facilitate the passage of ureteral stones [4][5].

Important Considerations

It's essential to note that treatment options for ureteral disease depend on various factors, including the type and severity of the condition. Patients should consult with their healthcare provider to determine the best course of treatment.

References:

[1] Stevermer JJ (2008) Prescribe tamsulosin or nifedipine for patients with lower ureteral calculi [1]

[2] Campschroer T (2018) Alpha-blockers are commonly used in MET, but their effectiveness remains controversial [2]

[3] (2022) To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen or naproxen sodium [3]

[4] (2023) Nifedipine facilitates the passage of ureteral stones [4]

[5] Fontenelle LF (2019) Alpha blockers are the first choice for pain relief in patients with kidney stones [5]

Differential Diagnosis of Ureteral Disease

The differential diagnosis of ureteral disease involves a wide range of conditions that can cause symptoms similar to those of ureteral stones, obstruction, or other ureteral pathologies. Here are some key points to consider:

• Ureteral Stones: The most common type of ureteral stone is a calcium stone, followed by uric acid stones [6]. Other types of stones include struvite and cystine stones.
• Obstructive Uropathy: This condition occurs when the flow of urine is blocked, causing the urine to back up and injure one or both kidneys [9].
• Ureteral Stricture: Narrowing of the ureteral lumen due to various diseases such as stones, trauma, tumors, specific infection or inflammation, retroperitoneal fibrosis (RPF), and radiotherapy [14].
• Ureteral Fibroepithelial Polyps: Rare benign tumors that are usually encountered in children but can also occur in adults [4].
• Transitional Cell Carcinoma of the Ureters or Bladder: A type of cancer that can cause symptoms similar to those of ureteral stones or obstruction [11].
• Lymphoma: A type of blood cancer that can affect the urinary tract and cause symptoms similar to those of ureteral disease [13].
• Sarcoidosis: An autoimmune disorder that can cause inflammation in various parts of the body, including the urinary tract [11].

Key Considerations

When considering a differential diagnosis for ureteral disease, it's essential to take into account the patient's symptoms, medical history, and any relevant laboratory or imaging studies. Some key considerations include:

• Acute Colicky Flank Pain: This symptom can be caused by various conditions, including ureteral stones, obstruction, or other ureteral pathologies [10].
• Nausea and Vomiting: These symptoms can occur in conjunction with acute colicky flank pain and are not unique to ureteral disease [10].
• Laboratory Studies: Urinalysis and blood tests may be necessary to rule out conditions such as pyelonephritis or kidney stones [2, 5].

References

[1] Context result 3 [4] Context result 4 [6] Context result 6 [9] Context result 9 [10] Context result 10 [11] Context result 11 [13] Context result 13 [14] Context result 14