Materiały źródłowe

• #1 Ureteral obstruction – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ureteral-obstruction/diagnosis-treatment/drc-20354680

  The goal of ureteral obstruction treatment is to remove blockages, if possible, or bypass the blockage, which may help repair damage to the kidneys. Treatment might include antibiotics to clear associated infections. […] A ureteral obstruction that causes severe pain might require an immediate procedure to remove urine from your body and temporarily relieve the problems caused by a blockage. Your doctor (urologist) may recommend: […] A ureteral stent, which is a hollow tube inserted inside the ureter to keep it open. […] Percutaneous nephrostomy, during which your doctor inserts a tube through your back to drain the kidney directly (percutaneous nephrostomy). […] A catheter, which is a tube inserted through the urethra to connect the bladder to an external drainage bag. This may be especially important if problems with your bladder also contribute to poor drainage of your kidneys.

• #2 Ureteral obstruction – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ureteral-obstruction/symptoms-causes/syc-20354676

  A ureteral obstruction is a blockage in one or both of the tubes (ureters) that carry urine from the kidneys to the bladder. Ureteral obstruction can be cured. However, if it’s not treated, symptoms can quickly move from mild pain, fever and infection to severe loss of kidney function, sepsis and death. […] Ureteral obstruction is fairly common. Because it’s treatable, severe complications are rare. […] Ureteral obstruction can lead to urinary tract infections and kidney damage, which can be irreversible.

• #3 Ureteral obstruction – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/ureteral-obstruction/

  The goal of ureteral obstruction treatment is to remove blockages, if possible, or bypass the blockage, which may help repair damage to the kidneys. Treatment might include antibiotics to clear associated infections. […] A ureteral obstruction that causes severe pain might require an immediate procedure to remove urine from your body and temporarily relieve the problems caused by a blockage. Your doctor (urologist) may recommend: A ureteral stent, which is a hollow tube inserted inside the ureter to keep it open. […] There are a number of surgical procedures used to correct ureteral obstructions. The type of procedure depends on your situation. […] Ureteral obstruction surgery may be performed through one of these surgical approaches: Endoscopic surgery. This minimally invasive procedure involves passing a lighted scope through the urethra into the bladder and other parts of the urinary tract. […] The main differences among these surgical approaches are your recovery time after surgery and the number and size of incisions used for the procedure. Your doctor (urologist) determines the type of procedure and the best surgical approach to treat your condition.

• #4 Obstructive uropathy – acute and chronic medical management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9846865/

  Obstructive uropathy is an important cause of acute and chronic kidney disease. Decompression of the urinary tract is an essential aspect of treatment. […] Standard therapeutic interventions for acute or chronic renal failure also apply for cases of obstructive uropathy. This narrative review summarises the early and long-term medical management of obstructive uropathy. […] Urinary tract decompression is the single most beneficial aspect of management; renal impairment is frequently reversible and the long-term renal prognosis is generally excellent. […] Subsequent medical care is an important but underappreciated supplement to surgical treatment. […] Prompt urinary system decompression is vital, which may be achieved through a variety of methods depending on the cause and site of blockage.

• #5

  https://www.aurorahealthcare.org/services/urology/ureteral-obstruction

  Ureteral obstructions are blockages in your urinary tract, which includes your kidneys, bladder, the tubes that carry urine from your kidneys to your bladder (ureters), and the tube that connects your bladder to the outside of your body (urethra). Blockages can develop for many reasons, including gastrointestinal problems and ureteral stones. […] Obstructions can be cured with surgery, but they need to be treated promptly. If theyre not, they can lead to severe illness, kidney damage and life-threatening infections. […] After youve been diagnosed, your doctor will work with you on a treatment tailored to your needs. Your treatment will likely involve surgery to remove blockages and repair any damage to your ureters and kidneys. […] Before your surgery, you may need temporary treatment to help your body get rid of urine. This could include: A catheter: Your doctor inserts a tube through your urethra into your bladder to drain urine. A ureteral stent: Your doctor inserts a tube into one or both of your ureters to help keep them open. Percutaneous nephrostomy: Your doctor inserts a tube through your back into your kidneys to drain them.

• #6 Urinary Tract Obstruction Treatment & Management: Medical Therapy, Surgical Therapy, Postoperative Details

  https://emedicine.medscape.com/article/438890-treatment

  Consultation with a urologist should be obtained in patients with urinary tract obstruction, as in hydronephrosis or urinary retention. A patient with complete urinary tract obstruction; any type of obstruction in a solitary kidney; obstruction with fever or infection; or renal failure needs immediate attention by a urologist. Patients with pain that is uncontrolled with oral medications or with persistent nausea and vomiting that causes dehydration also need immediate urological attention. […] A partial urinary tract obstruction in the absence of infection can be initially managed with analgesics and prophylactic antibiotics until a complete urologic evaluation is performed and definitive management is completed. […] The goal of surgical intervention is to completely relieve the urinary tract obstruction. This can be evaluated with reimaging to ensure that the obstruction is resolved, as well as kidney function monitoring with creatinine testing. The recovery of renal function depends on the severity and duration of the obstruction.

• #7 Navigating Ureteral Obstruction: Causes, Symptoms & Treatment

  https://ugatl.com/blog/ureteral-obstruction/

  How is a Ureteral Obstruction Treated? […] Treating ureteral obstructions aims to remove the blockage and restore proper urine flow. The specific treatment depends on the cause and severity of the obstruction. Here are common approaches: […] Medications: If the obstruction is caused by urinary tract infections (UTIs) or inflammation, antibiotics or anti-inflammatory medications may be prescribed to clear the infection and reduce swelling. These medications can help alleviate symptoms and prevent further complications. […] Ureteral Stent: A ureteral stent is a thin, flexible tube thats inserted into the ureter to bypass the obstruction and allow urine to drain from the kidney to the bladder. This is often done as a temporary measure to relieve symptoms while waiting for other treatments or for the obstruction to resolve on its own.

• #7 Navigating Ureteral Obstruction: Causes, Symptoms & Treatment

  https://ugatl.com/blog/ureteral-obstruction/

  Nephrostomy Tube: In some cases, particularly if the obstruction is severe or the ureteral stent cannot be placed, a nephrostomy tube may be inserted directly into the kidney to drain urine. This tube exits through the skin and is connected to a drainage bag outside the body. […] Surgery: Surgical intervention may be necessary to remove the underlying cause of the obstruction, such as kidney stones, tumors, or scar tissue. Procedures like ureteroscopy, lithotripsy (breaking up kidney stones with sound waves), or open surgery may be performed depending on the specific situation.

• #8 Urinary Tract Obstruction Treatment & Management: Medical Therapy, Surgical Therapy, Postoperative Details

  https://emedicine.medscape.com/article/438890-treatment

  Different interventions can be performed to temporarily relieve the obstruction. Surgical intervention is usually obtained once the point of obstruction is identified with radiographic imaging. […] Before any surgical intervention or any manipulation of the urinary tract, broad-spectrum antibiotics should be initiated to prevent infection or urosepsis. […] Upper urinary tract obstruction (ureter, kidney) can be relieved with a ureteral stent or a nephrostomy tube. […] A ureteral stent is a flexible tube that extends from the renal pelvis to the bladder. It can be placed during cystoscopy to relieve obstruction along any point in the ureter. […] A nephrostomy tube is a flexible tube that is placed through the back directly into the renal pelvis. If a ureteral stent cannot be placed cystoscopically in a retrograde fashion, a percutaneous nephrostomy tube can be inserted for relief of hydronephrosis.

• #9 Ureteral Obstruction | UMass Memorial Health

  https://www.ummhealth.org/services-treatments/urology/uteteral-obstruction

  A ureteral obstruction is a blockage in your ureters, the tubes that carry urine from your kidneys to your bladder. […] Fast, effective treatment from the urologists at UMass Memorial Health can help you find relief and prevent dangerous health complications. […] If you’ve been diagnosed with a ureteral obstruction or have concerning symptoms, our urologists are here to deliver a prompt diagnosis and treatment. Our first priority is to drain urine from your body to relieve symptoms and prevent permanent damage to your kidneys and urinary tract. […] Addressing the common causes of urethral obstruction can provide longer-term relief. Doctors with a depth of experience at UMass Memorial Medical Center offer: […] Ureteral stenting: We use imaging guidance to thread a stent (thin tube) through your urethra and up to the blocked ureter. The stent holds the ureter open so urine can pass.

• #10 Update on the Management of Malignant Ureteral Obstruction – American Urological Association

  https://auanews.net/issues/articles/2023/may-2023/update-on-the-management-of-malignant-ureteral-obstruction

  Malignant ureteral obstruction (MUO) is a common condition for urologists to manage. MUO may result from obstruction of a primary urothelial tumor, direct invasion from a nonurological malignancy, or compression from a tumor or metastatic lesion. […] MUO is associated with unfavorable oncologic prognosis with patients typically having a life expectancy of less than 1 year. Individualized prognosis and end of life or quality of life goals must be considered when deciding whether to intervene with ureteral decompression given that treatment-related side effects can lead to significant decreases in quality of life. […] Upper tract decompression can be carried out through several approaches. Cystoscopy with retrograde double-J stenting (DJS) is often the initial management for MUO, but it has limitations.

• #11 Update on the Management of Malignant Ureteral Obstruction – American Urological Association

  https://auanews.net/issues/articles/2023/may-2023/update-on-the-management-of-malignant-ureteral-obstruction

  If a DJS fails, placement of tandem ureteral stents (TUSs) is another option. […] To better withstand external compressive forces, metallic stents have been developed. […] A reinforced silicone stent is also available in the U.S. […] Placement of a percutaneous nephrostomy (PCN) is traditionally the next step when stenting is not successful, not tolerated, or in stent failure. […] Another diversion that can be used in the setting of MUO is permanent subcutaneous pyelovesical bypass. […] In conclusion, MUO can be managed with DJS, tandem ureteral stents, reinforced stents, metallic stents, PCN tubes, or extra-anatomical urinary diversion. All have potential downsides, so quality of life effects of each option, frequency of exchanges, and cost of exchange procedures should be taken into consideration. The indication for decompression should be weighed against goals of care and perceived benefits of decompression, such as ability to receive treatment such as chemotherapy or palliation of symptoms related to obstruction.

• #12 Ureteral Obstruction Treatment in South Florida | Nephrostomy Tube

  https://www.flinterventional.com/treatments/kidney-and-dialysis/nephrostomy-tube-ureteral-stents/

  A nephrostomy tube and ureteral stents are medical interventions used to temporarily assist with urine drainage from the body. […] The goal of treatment is to remove or bypass blockages in the ureter and drain the buildup of urine in the kidneys. This allows the kidneys time to return to normal functioning if possible, as well as time for an infection, if present, to clear. It also protects the affected kidney from further damage. Treatment methods to restore proper flow of urine through an obstructed ureter will depend on the cause of the blockage and whether infection, inflammation, or other complications are present. […] Two common methods of allowing urine to successfully drain from the kidneys are the use of ureteral stents and a nephrostomy tube. […] A nephrostomy tube is a catheter inserted through the skin at your lower back and into the affected kidney, under real-time imaging guidance. This method effectively bypasses the obstruction, allowing urine to exit the kidney through the catheter (nephrostomy tube) and into an external drainage bag. […] The interventional radiologists at Florida Endovascular and Interventional are specially trained and experienced at the placement of both ureteral stents and nephrostomy tubes. […] Should you require urine drainage or diversion as a result of a ureteral obstruction, we can help.

• #13

  https://www.nhs.uk/conditions/hydronephrosis/treatment/

  Treatment for hydronephrosis depends on what’s causing the condition and how severe it is. […] Most people with hydronephrosis will have a procedure called urinary catheterisation to drain the urine from their kidneys. […] Depending on the underlying cause, medication or surgery may be needed afterwards to correct the problem. […] The first stage in treating hydronephrosis is to drain the urine out of your kidneys. […] A thin tube called a catheter may be inserted into your bladder through your urethra (the tube that carries urine out of the body). […] Once the pressure on your kidneys has been relieved, the cause of the build-up of urine may need to be treated. […] Narrowing of the ureter (the tube that runs from the kidney to the bladder) can be treated by inserting a hollow plastic or metal tube called a stent, which allows urine to flow through the narrowed section this can often be done without making cuts in your skin. […] Painkillers and antibiotics can also be given if you’re in pain or develop a UTI. […] If ANH does not get better by itself, your child may need to keep taking antibiotics.

• #14 Ureteral Obstruction: Causes, Symptoms and Risk Factors

  https://www.prepladder.com/neet-pg-study-material/surgery/ureteral-obstruction-causes-symptoms-risk-factors-diagnosis-and-treatment

  The goal of ureteral obstruction treatment is to either clear the obstruction or avoid it altogether, which may help restore kidney damage. Antibiotics might be part of the treatment to get rid of infections that are connected. […] If a ureteral obstruction is causing excruciating agony, you may need an urgent operation to remove the obstruction’s urine from your body and temporarily alleviate the problems it has brought. Your urologist may suggest: […] To keep the ureter open, a hollow tube known as a ureteral stent is inserted inside of it. […] Percutaneous nephrostomy, in which a catheter is inserted through your back by your doctor to drain your kidneys directly. […] A catheter, or tube inserted into the urethra, is used to link an external drainage bag to the bladder. This may be especially important if you also have problems with your bladder that cause insufficient renal discharge.

• #15 Living with Ureteral Obstruction: Coping Strategies and Support

  https://www.darwynhealth.com/kidney-and-urinary-tract-health/urinary-tract-disorders/obstruction-of-the-urinary-tract/ureteral-obstruction/living-with-ureteral-obstruction-coping-strategies-and-support/?lang=en

  Ureteral obstruction refers to the blockage or narrowing of the ureter, which is the tube that carries urine from the kidneys to the bladder. […] It is important to seek medical attention if you suspect you may have ureteral obstruction. A healthcare professional can diagnose the condition through various tests, such as imaging studies and urine tests. Treatment options may include medications to manage symptoms, procedures to remove obstructions, or surgery to repair or bypass the affected area. […] Medications play a crucial role in managing the symptoms and complications associated with ureteral obstruction. The primary goal of medication therapy is to alleviate pain, relax the muscles, and prevent or treat any potential infections. […] Pain relievers are commonly prescribed to help manage the discomfort caused by ureteral obstruction. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen sodium can effectively reduce pain and inflammation.

• #16 Ureteral Obstruction: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21155-ureteral-obstruction

  The treatment you receive depends on the reason for the blockage. First, your healthcare provider will perform a procedure to allow the pee to drain from your body. These procedures include: […] Common treatments for ureteral obstruction are: […] If an enlarged prostate is causing the blockage, doctors may prescribe an alpha-blocker to relax your prostate muscles. A medicine called finasteride (Proscar) can shrink your prostate. […] There are several different surgical methods to treat a ureteral blockage from minimally invasive office procedures to open abdominal surgery. Your healthcare provider will decide what type of surgery is necessary based on your situation. With each type, your surgeon removes the blockage and repairs your ureter. […] The side effects of alpha-blockers include dizziness, headaches and fainting. Side effects of finasteride (Proscar), the medication used to shrink your prostate, include decreased sexual desire and increased hair growth. […] Surgery to remove the obstruction can have side effects such as discomfort and increased risk of infection. Each type of surgery carries its own risks. Your healthcare provider can discuss the risks of each type of surgery with you.

• #17 Living with Ureteral Obstruction: Coping Strategies and Support

  https://www.darwynhealth.com/kidney-and-urinary-tract-health/urinary-tract-disorders/obstruction-of-the-urinary-tract/ureteral-obstruction/living-with-ureteral-obstruction-coping-strategies-and-support/?lang=en

  Muscle relaxants are another class of medications that can provide relief for individuals with ureteral obstruction. […] In some cases, ureteral obstruction can lead to urinary tract infections (UTIs) or kidney infections. Antibiotics are prescribed to treat these infections and prevent further complications. […] Overall, medications play a significant role in the management of ureteral obstruction. They help alleviate pain, relax muscles, and treat associated infections. However, it is essential to use them under the guidance of a healthcare professional and be aware of potential side effects.

• #18 Obstructive Uropathy in Dogs and Cats – Urinary System – Merck Veterinary Manual

  https://www.merckvetmanual.com/urinary-system/noninfectious-diseases-of-the-urinary-system-in-small-animals/obstructive-uropathy-in-dogs-and-cats

  Treatment can include a combination of IV fluid therapy, diuretics, and medications (eg, prazosin in cats [0.250.5 mg/kg, PO, every 1224 hours as needed], tamsulosin in cats [0.0040.006 mg/kg, PO, every 1224 hours as needed]) that relax ureteral smooth muscle. Obstructions that do not respond to medical management within 2472 hours should be relieved with ureteral surgery (eg, ureterotomy, ureteroneocystostomy) or surgical placement of a subcutaneous ureteral bypass or ureteral stent to prevent ongoing kidney damage. […] Postobstructive diuresis, requiring longer and more intensive management, can develop after correction of urethral or ureteral obstructions. After relief of obstruction, animals can produce urine volumes well above normal, requiring careful monitoring and adjustment of fluid and electrolyte therapy to prevent dehydration and hypokalemia. Patients with more severe azotemia before relief of obstruction are more likely to experience more severe and prolonged postobstructive diuresis.

• #19 Urinary Tract Obstruction (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/urinary-tract-obstruction

  Ureterolysis or stent placement is undertaken to relieve the obstruction. […] Acute retention requires urinary catheterisation. […] Medical treatment involves the use of alpha1-blockers and 5-alpha reductase inhibitors. […] Surgery is less frequent now given more effective medical treatment and, increasingly, offers less invasive options compared with the standard transurethral resection of the prostate (TURP), such as transurethral microwave thermotherapy or various laser procedures.

• #19 Urinary Tract Obstruction (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/urinary-tract-obstruction

  Urinary tract obstruction treatment and management […] Where there is complete urinary tract obstruction, patients require procedures to relieve the blockage urgently. These may include: […] Urethral or suprapubic catheterisation. […] Stenting the ureter. […] Nephrostomy. […] Involve a general/renal physician early on in management if there is evidence of renal impairment in association with urinary tract obstruction. […] Options for treatment include: […] Pyeloplasty which can be done as an open, laparoscopic or robot-assisted procedure. […] Endopyelotomy (full-thickness incision through the stenosis leaving a stent in situ temporarily) – this may be done via a percutaneous or endoscopic approach. […] Ureteric stenting or percutaneous nephrostomy is required to relieve the obstruction.

• #20 Ureteral obstruction – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ureteral-obstruction/diagnosis-treatment/drc-20354680

  Your doctor can tell you which procedure or combination of procedures is best for you. Drainage procedures might provide temporary or permanent relief, depending on your condition. […] There are a number of surgical procedures used to correct ureteral obstructions. The type of procedure depends on your situation. […] Ureteral obstruction surgery may be performed through one of these surgical approaches: […] Endoscopic surgery. This minimally invasive procedure involves passing a lighted scope through the urethra into the bladder and other parts of the urinary tract. The surgeon makes a cut into the damaged or blocked part of the ureter to widen the area and then places a hollow tube (stent) in the ureter to keep it open. This procedure may be done to both diagnose and treat a condition.

• #21 Urethral obstruction – Humanitas.net

  https://www.humanitas.net/diseases/urethra-obstruction/

  Treatment options for urethral obstruction typically includes surgery or stent placement. […] The main focus on treating urethral obstruction is removing the obstruction from the blocked ureters in order to prevent serious complications from occurring. Treatment options can include: […] Percutaneous nephrostomy: A procedure that involves the insertion of a tube through the back to drain the kidney directly. […] Catheterization: A procedure that involves the insertion of a tube (catheter) through the urethra to connect the bladder to an external drainage bag. […] Surgical procedures to correct ureteral obstruction include: […] Endoscopic surgery: A surgical procedure that involves inserting a lighted scope into the damaged or blocked part of the ureter in order to open blocked areas and provide short term relief of symptoms.

• #21 Urethral obstruction – Humanitas.net

  https://www.humanitas.net/diseases/urethra-obstruction/

  Ureterolysis: A surgical procedure that exposes the ureter and frees it from abnormal fibrous or scar tissues. […] Pyeloplasty: A surgical procedure that involves repairing any damage to the ureter and inserting a hollow tube (stent) to keep it open. […] Partial nephrectomy: A surgical procedure that involves removing any damaged areas of the kidney caused by urethral obstruction. […] Ureterectomy: A surgical procedure that involves removing all or part of a ureter, reconstructing the urinary tract by lowering the kidney and stretching the bladder up or replacing the ureter using other body tissue. […] Ureteral reimplantation: A surgical procedure that involves taking out a section of the ureter, reconnecting the healthy sections to each other and reattaching them to the bladder. […] Transureteroureterostomy: A surgical procedure that involves joining one ureter to another in order to improve renal function.

• #22 Review of the current management of radiation-induced ureteral strictures of the pelvis – Srikanth – AME Medical Journal

  https://amj.amegroups.org/article/view/6496/html

  The primary indication for PCN tube placement is decompression of the urinary tract due to obstruction, which can be benign or malignant in nature including ureteral radiation injury. PCN is usually performed under ultrasound or fluoroscopy guidance with the patient in a prone position. It is considered a safe intervention with a success rate of 90% and low risk of major complications. […] Balloon dilatation has been studied in the setting of benign and malignant ureteral strictures. Numerous studies have found that location in the mid-ureter is associated with higher failure rates than proximal and distal strictures. Additionally, RIUS, which tends to be long and ischemic in nature, does not respond well to balloon dilatation therapy as neovascularization during the healing process is compromised.

• #22 Review of the current management of radiation-induced ureteral strictures of the pelvis – Srikanth – AME Medical Journal

  https://amj.amegroups.org/article/view/6496/html

  Radiation-induced ureteral stricture (RIUS) can cause infection, hydronephrosis, kidney stone formation, and ultimately, renal failure. Management of RIUS is a challenge to urologists as the strictures tend to be long, bilateral, and ischemic in etiology. Management of RIUS is divided into endoscopic, open, and minimally invasive techniques. Stents and percutaneous nephrostomy (PCN) tubes are generally used as temporizing measures until definitive repair, but they may be a long-term option for patients unfit for surgery. Balloon dilatation and endoureterotomy have shown efficacy between 60-80% but are less effective in radiation-induced stricture due to the ischemic nature of the insult. Ureteroureterostomy (UU) is best suited for short strictures in the mid-to-proximal ureter. Ureteroneocystostomy is better suited for longer strictures in the distal ureter and may be paired with psoas hitch or Boari flap to increase coverage length. Importantly, for radiation patients, bladder fibrosis may be a contraindication to these procedures. Buccal graft ureteroplasty is increasingly being used with success rates between 80-90%, although this number decreases to around 30% in longer strictures. Finally, bowel substitutes are suitable for longer strictures and bilateral disease. Most recently, appendiceal interposition has been studied for both right- and left-sided strictures around 3-5 cm, with success rates around 70%. In general, minimally invasive approaches, while less studied, have demonstrated similar clinical outcomes and complication rates, with less pain and shorter hospital stays.

• #23 Review of the current management of radiation-induced ureteral strictures of the pelvis – Srikanth – AME Medical Journal

  https://amj.amegroups.org/article/view/6496/html

  Endoureterotomy should only be considered in patients with RIUS as a temporizing measure, with discussion of a more definitive surgical reconstruction at the time of initial presentation, or in patients who are not fit for open intervention. […] Ureteroneocystostomy, or ureteral reimplant into the bladder wall, is indicated in patients with distal strictures of the ureter up to 5 cm in length. This is an optimal approach if the distal blood supply of the ureter is tenuous, as it allows the surgeon to debride back to viable tissue and spatulate the ureter to prepare for reimplantation. […] Graft ureteroplasty has been used to address the challenges associated with surgical management of RIUS, allowing the surgeon to supplement the diseased tissue while avoiding the morbidity of bowel substitution or renal autotransplantation. This procedure can be performed in an open or robot-assisted laparoscopic fashion and achieve tension-free anastomosis for strictures too long for repair with UU (2 cm) in the proximal to mid-ureter.

• #24 Ureteropelvic Junction (UPJ) Obstruction Treatment in NJ | Hackensack Meridian Health

  https://www.hackensackmeridianhealth.org/en/services/urology/upj-and-reconstruction

  Ureteroureterostomy: When the blockage occurs in the top or middle section of the ureter, the surgeon removes the obstructed area and connects the remaining portions of the ureter. If the stricture is small enough, a laser may be used to cut the stricture without the need for robotic surgery. […] Ureteral Reimplantation: The surgeon removes the ureter directly above the blockage, creates a new opening in the bladder and attaches the end of the ureter to this opening. […] Ureterolysis: The surgeon removes a mass of tissue or scar tissue that is pressing on one or both ureters known as retroperitoneal fibrosis.

• #24 Ureteropelvic Junction (UPJ) Obstruction Treatment in NJ | Hackensack Meridian Health

  https://www.hackensackmeridianhealth.org/en/services/urology/upj-and-reconstruction

  If surgery is required, we use robotic surgical approaches whenever possible to correct UPJ and other ureteral strictures. […] We offer New Jerseys most experienced robotic surgery team and have pioneered many procedures used for ureteral strictures. […] We also use enhanced imaging techniques during surgery to ensure successful reconstruction. […] Robotic Pyeloplasty: The surgeon removes the blockage and the ureter is surgically reconstructed. This also helps prevent future problems. […] Buccal Mucosa Ureteroplasty: When scarring is so severe that pyeloplasty cannot be performed, the surgeon rebuilds the ureter using tissue from inside of the mouth. […] Ureterocalicostomy: The surgeon removes the obstructed section of the ureter and reattaches the ureter to the bottom of the kidney where urine forms and collects.

• #25 Urinary Obstruction and Ureteral Stricture: Causes and Treatment

  https://www.saintjohnscancer.org/urology/conditions/urinary-obstruction-urologic-reconstruction/

  Urinary obstruction can be the result of a variety of conditions. Our goal is to offer immediate and lasting relief, utilizing minimally invasive and best-practice techniques. […] A blockage that prevents the voiding of urine can cause a variety of problems, including pain and infections. […] Urology Oncology Team – Saint Johns Cancer Institute Doctors; Mehran Movassaghi, MD, Timothy Wilson, MD, Przemyslaw Twardowski, MD, and Jennifer Linehan, MD are ready to support you […] Robotic Pyleoplasty eliminates the obstruction by surgically removing the affected tissue and rejoining the ureter to the kidney. […] Pyeloplasty has the best success for patients with UPJ obstruction. […] UPJ obstruction can be treated with surgery called a pyleoplasty. […] Ureteroplasty is a procedure and surgery that can fix narrowing of the ureterstubes in the body that carry urine from the kidneys to the bladder. […] When scarring occurs in the ureter, urine does not drain well. This is often painful and can lead to infection and long-term kidney damage.

• #26 Ureteral Obstruction Treatment | University of Utah Health

  https://healthcare.utah.edu/urology/conditions/ureteral-stricture-obstruction/treatment

  When the bladder is unhealthy on the side of the stricture and the ureter cannot be attached to the bladder successfully, then the ureter can be brought to the other side of the abdomen and attached to the healthy opposite ureter. This allows for healthy drainage down the normal ureter to the bladder. […] When the ureter has scar that is too extensive to manage with one of the above surgeries or the patient has conditions such as radiation damage, another option is replacing the ureter with a piece of small bowel. This segment of bowel attaches between the kidney and the bladder. This allows for easy drainage of urine into the bladder and is also very successful. […] A procedure with a greater success is called a pyeloplasty. In this surgery, the segment of the ureter that is causing the obstruction is removed and the normal ureter is sewn to the pelvis of the kidney. This surgery can be done laproscopically or with an open incision and is very successful by either method.

• #26 Ureteral Obstruction Treatment | University of Utah Health

  https://healthcare.utah.edu/urology/conditions/ureteral-stricture-obstruction/treatment

  Ureteral obstruction is treated with several types of surgery when management with drains, stents, or medicines fail. These can include the following: […] The type of surgery that is needed depends upon the location of the scar, the cause and the length of the scar. […] In a ureteral re-implant the ureter is cut where the stricture ends and the ureter is reattached to the top of the bladder. Several things can be done to bridge the gap between the ureter and the bladder, such as pulling the bladder over towards the ureter and attaching it to the muscles of the abdomen (psoas hitch) or creating a large flap of bladder to meet the ureter (Boari flap). This type of surgery is very successful. […] This surgery works well when there is a short stricture along the coarse of the ureter in the mid to upper portion of the ureter. In this surgery a short stricture is cut out, and the ureter is reattached to itself.

• #27 Renal Obstruction & Ureteral Strictures – Kidney Stones & Urinary Obstruction | UCLA Health

  https://www.uclahealth.org/medical-services/urology/kidney-stone/renal-obstruction-ureteral-strictures

  Percutaneous (antegrade) technique Using a small incision, a camera is introduced into the kidney directly through the skin between the ribs and the hip. The surgeon then uses various techniques to open up the blockage. […] Robotic-assisted laparoscopic pyeloplasty Through a few small incisions in the abdomen, the surgeon uses laparoscopic instruments to remove the blockage and reconnect the healthy part of the kidney to the healthy ureter. This technique offers the highest success rate. […] A narrow silicone tube called a stent may be placed after these procedures to allow the area to heal properly while draining the kidney. The stent is removed a few weeks later in the office.

• #28 Definitive treatment options for ureteral obstruction | Abdominal Key

  https://abdominalkey.com/definitive-treatment-options-for-ureteral-obstruction/

  Definitive treatment options for ureteral obstruction […] While temporizing measures such as stents and nephrostomy tubes with scheduled changes can offer a definitive solution in select situations such as end-of-life care and poor surgical candidates, in general, the goal in managing upper urinary tract obstruction should be a definitive repair that reestablishes normal drainage from the kidney to the bladder and avoids the needs for stents or nephrostomy tubes. […] The goal of repair should be symptom relief and preservation of renal function. […] When treatment is indicated, the procedure of choice is a pyeloplasty (open, laparoscopic, robotic), though endourologic incisional procedures can be considered as well, particularly in the case of secondary UPJO. […] Pyeloplasty is most commonly performed in a dismembered fashion whereby the abnormal portion of ureter is fully incised, and the healthy end of the ureter is reanastamosed to the renal pelvis. […] In the case of a small intrarenal pelvis, a ureterocalicostomy can be performed by transecting the lower pole of the kidney and anastomosing the ureter to the lower pole calyx.

• #29 Ureteral Obstruction

  https://www.umassmed.edu/urology/clinical-conditions/ureteral-obstruction/

  Ureteral obstruction occurs when a ureter becomes blocked. […] Surgery to address a blocked ureter can restore normal function in the urinary system. […] Today these procedures are often done with minimally invasive techniques that use a tiny camera and tiny instruments inserted through small incisions in the belly. […] These procedures include: Pyeloplasty, in which the blockage is located and cut away or divided with a laser […] Ureteral reimplantation, in which the obstructed part of the ureter is cut away and the ureter is then sewn back together. […] In either surgery, the surgeon may also place a stent a small rigid tube to help hold the ureter open that is then removed in a later procedure when the ureter has healed.

• #30 Ureteral obstruction – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ureteral-obstruction/diagnosis-treatment/drc-20354680

  Open surgery. The surgeon makes an incision in your abdomen to remove the blockage and repair your ureter. […] Laparoscopic surgery. In this approach, the surgeon makes one or more small incisions through your skin to insert a small tube with a light, a camera and other instruments needed for the procedure. […] Robot-assisted laparoscopic surgery. The surgeon uses a robotic system to perform a laparoscopic procedure. […] The main differences among these surgical approaches are your recovery time after surgery and the number and size of incisions used for the procedure. Your doctor (urologist) determines the type of procedure and the best surgical approach to treat your condition.

• #31 Ureteral Obstruction: Causes, Symptoms, Diagnosis and Treatment | Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/ureteral-obstruction-causes-symptoms-diagnosis-and-treatment

  Open surgery: An incision is made into your abdomen to carry out the procedure. […] Endoscopic surgery: A minimally invasive procedure where a scope is passed through the urethra into the bladder […] Laparoscopic Robot-assisted surgery: A small incision is made through your skin, and a small tube with a camera and light is inserted and the procedure is done. Sometimes, a robotic system is also used to perform surgery. […] Ureteral obstructions are common but can be treated with drainage/surgical procedures if detected early. If you experience any of the symptoms mentioned above, contact medical experts immediately.

• #32 Ureteral & Uretero-Pelvic Junction Treatment | UC Irvine Health | Department of Urology

  https://www.urology.uci.edu/kidney_stones_kidney_disease_ureteral_uretero_pelvic_junction_treatment.shtml

  Surgery for ureteral and uretero-pelvic junction can correct the problem quickly. […] It is treatable through corrective surgery. […] Severe cases in children and most cases in adult patients require surgery. Traditional open surgery to remove the blockage and repair the ureteropelvic junction is known as a pyeloplasty. This technique is still best for more severe cases of UPJ and for very young patients. Drainage tubes will be used afterward to help heal the site. […] Traditional open surgery to remove the blockage and repair the ureteropelvic junction is known as a pyeloplasty. This technique is still best for more severe cases of UPJ and for very young patients. Drainage tubes will be used afterward to help heal the site.

• #33

  https://www.aurorahealthcare.org/services/urology/ureteral-obstruction

  Your surgery may be traditional or laparoscopic. Laparoscopies are minimally invasive surgeries that decrease pain, bleeding, complications and recovery time. […] Aurora specializes in: Laparoscopic pyeloplasty: Your surgeon makes small incisions in your abdomen and uses precise instruments, including a tiny camera called an endoscope, to remove obstructions from your urinary tract. Robotic pyeloplasty: This is similar to a laparoscopic pyeloplasty, but your surgeon uses robotic instruments in the procedure.

• #34 Ureteral Obstruction: Causes, Symptoms and Risk Factors

  https://www.prepladder.com/neet-pg-study-material/surgery/ureteral-obstruction-causes-symptoms-risk-factors-diagnosis-and-treatment

  Laparoscopic techniques: By making one or more tiny skin incisions, the surgeon uses this technique to introduce a tiny tube that houses a light, a camera, and other necessary instruments for the procedure. […] Robotic support for laparoscopic surgeries: The surgeon uses a robotic instrument to do the laparoscopic surgery. […] The main differences between different surgical techniques are the amount of time needed for recovery after surgery and the number and size of incisions created during the procedure. It is your urologist’s decision what kind of procedure and surgical approach is best for treating your disease.

• #35 Ureteropelvic Junction Obstruction | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/ureteropelvic-junction-obstruction

  Should your child’s doctor decide that he needs surgery, our surgeons have vast experience in both traditional open and minimally invasive robotic-assisted surgical procedures. […] The goal of the surgery is to remove the blockage in the ureter and allow urine to flow properly. […] We often perform state-of-the-art robotic surgery to treat UPJ obstructions. […] If your child’s doctor decides that it’s best to perform a traditional open procedure, the incision will be larger and your child will typically stay in the hospital for a few more days, but the procedure has proven very effective over the years and the results will be very similar. […] If left untreated, however, the chronic backup of urine into the kidney can damage your child’s kidneys.

• #36 Preparing for ureteral stricture treatment | University of Iowa Health Care

  https://uihc.org/educational-resources/preparing-ureteral-stricture-treatment

  If the stricture is on the inside of the ureter, your doctor may use endoscopic ureteral dilation/incision. This procedure stretches or cuts the ureter to help make it larger so that urine can drain from the kidney. […] If you and your doctor want a permanent fix, you may need reconstructive surgery. This is often only done after ureteral stents, percutaneous nephrostomy tubes, or ureteral dilation/incision have not worked. […] There are many different surgeries used to repair a ureteral stricture. You and your doctor will discuss which one is the right one for your stricture. […] Ureteral reimplantation: This is the most common type of ureteral reconstruction. The ureter is cut just above the narrowing, then it is sewn into a new place in the bladder. […] If ureteral reconstruction might cause more harm than good, or if the MAG-3 renal scan shows the kidney is not working well, you and your doctor may decide that it is best to remove the kidney. The other kidney must be healthy before this is done.

• #37 Subcutaneous nephrovesical bypass: Treatment for ureteral obstruction in advanced metastatic disease

  https://www.spandidos-publications.com/10.3892/ol.2014.2679

  Subcutaneous nephrovesical bypass (SNVB) is a minimally invasive, effective and safe procedure for patients with ureteral obstruction resulting from advanced malignant disease. […] The aim of the present study was to maintain an acceptable patient QoL and restore kidney function by performing SNVB in 24 patients. […] SNVB is suitable for patients with ureteral obstruction due to advanced abdominal pelvic malignancy without radical surgery. […] In conclusion, SNVB is a minimally invasive, safe and effective procedure that can improve renal pelvic drainage for ureteral obstruction patients with end-stage malignancies. SNVB offers patients a better QoL and should be considered an alternative procedure to PCN, which is documented to reduce QoL due to the need for cumbersome external urine collection devices.

• #38

  https://journals.lww.com/cur/fulltext/2024/03000/the_challenging_management_of_malignant_ureteral.8.aspx

  Malignant ureteral obstruction (MUO) is a common condition that complicates the course of advanced malignancies. The aims of this study are to analyze the causes, management, and survival of patients with obstructive nephropathy due to malignant ureteric obstruction and to determine prognostic factors. […] Treatment of obstructive uropathy depends on the etiology, ranging from palliative to curative options. Malignant ureteral obstruction is treated by ureteral stenting or PCN, depending on the demands of the patients condition. […] Urinary diversion is often a lifelong solution in these patients. Although ureteric stents and PCNs are the initial treatment options, other alternative treatments could be considered in selected patients, such as new compression-resistant metallic stents, urinary subcutaneous diversion with a nephrovesical stent, or even ureteral reimplantation.

• #39 Review of the current management of radiation-induced ureteral strictures of the pelvis – Srikanth – AME Medical Journal

  https://amj.amegroups.org/article/view/6496/html

  The two main goals of intervention in RIUS are to preserve renal function and relieve ureteral obstruction. Endoscopic management for RIUS offers a low-cost, low-morbidity alternative to formal ureteral reconstruction in carefully selected patients. The highest rates of success are in patients with short (2 cm) strictures that are benign in etiology, nonischemic, and located in the proximal or distal ureter. Patients who are poor surgical candidates can potentially be treated successfully with an endoscopic treatment. However, endoscopic treatments are generally less effective in radiation-induced strictures because of the ischemic nature of the stricture and the decreased regenerative capacity of irradiated tissue. […] Ureteral stents in the setting of RIUS can be used as a temporary treatment until a more definitive treatment option can be planned, especially in patients with an acute need for decompression. Use of stents for decompression is not restricted by length of ureteral stricture and ureteral stents can generally be placed either in a retrograde or anterograde fashion quickly and safely.

• #40

  https://journals.lww.com/transplantjournal/abstract/2018/07001/surgical_treatment_for_ureteral_obstruction_after.1008.aspx

  Ureteral obstruction occurs in 2% to 10% of renal transplant patients postoperatively, usually presenting within the first few weeks or the first year. Ureteric ischemia is the most common cause, accounting for around 90% of occurrences. The first option for treatment is interventional radiological methods. […] If all of these methods are unsuccessful, surgical treatment should be applied. […] We evaluate the outcomes of 5 patients who treated with surgical techniques for ureteral obstruction. […] The interventional radiological methods are the first choice for treatment, surgical procedures should be performed in patients who do not benefit from these treatments.

• #41 Obstructive uropathy – acute and chronic medical management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9846865/

  However, collaboration with nephrologists may be requested because sudden decompression is frequently complicated by abnormal fluid and electrolyte balance and long-term renal insufficiency. […] This evidence-based narrative review outlines the acute and post-decompression medical management of obstructive uropathy. […] Definitive urologic surgery should be delayed if possible until after the patient is medically stable and urgent decompression has been accomplished. […] Medical issues requiring optimisation are often encountered at this initial presentation rather than the time of elective surgery. […] An early post-decompression polyuric phase with electrolyte losses is common, requiring judicious monitoring and replacement. […] Many patients develop CKD and should receive long-term nephrology follow-up. […] The kidney-specific prognosis is generally favourable with few patients proceeding to dialysis. […] Obstructive uropathy is a potentially reversible condition. Surgical decompression of the urinary system is the key component of care, but many surrounding medical issues must also be considered.

• #42 Obstructive Uropathy: From Etiopathology to Therapy | Mourmouris | World Journal of Nephrology and Urology

  https://wjnu.org/index.php/wjnu/article/view/154/99

  However, in some hospitals, percutaneous nephrostomy is placed only by the interventional radiologists that may not be available in an emergency basis. […] In patients that receive anti-coagulation medication, the preferred therapy is JJ stent placement whereas in the case of urosepsis, percutaneous nephrostomy placement is the gold standard therapy. […] In obstructive uropathy due to cancer, there may be difficulties during the insertion of a JJ stent. […] After the management of the obstruction, polyuria may happen, especially in cases of bilateral obstruction or obstruction in a solitary kidney. […] Monitoring the level of consciousness and the vital signs, electrolyte supplementation and a gradual reduction of the administered intravenous fluids are essential. […] It appears that patients age, duration of obstruction, initial renal function and existence of urine extravasation are prognostic factors.

• #43 Ureteric obstruction – Birmingham Urology Centre

  https://birminghamurologycentre.com/conditions/ureteric-obstruction/

  Your treatment will depend on the severity and cause of the obstruction. Options include: […] Ureteral stents: A stent is inserted into the ureter to keep it open and allow urine to pass from the kidney to the bladder. […] Percutaneous nephrostomy: A tube is placed directly into your kidney to drain urine, bypassing the blockage. […] Surgery: To remove the obstruction or correct the underlying issue. Surgical options may include open surgery, laparoscopic (keyhole) surgery, or robotic-assisted techniques, depending on your specific case. […] Post-treatment care is crucial for your recovery and preventing recurrence: […] Follow-up care: Regular check-ups to monitor your kidney function and ensure the obstruction does not return. […] Pain management: You may be prescribed pain relief medication to manage any discomfort. […] Hydration: Drink plenty of fluids to help flush your urinary system and reduce the risk of further blockages. […] At Birmingham Urology Centre, we combine advanced technology with expert care to provide effective treatment for ureteric obstruction.

• #44 Ureteral obstructions in dogs and cats – interventional radiology treatment options – Veterinary Practice

  https://www.veterinary-practice.com/article/ureteral-obstructions-in-dogs-and-cats-interventional-radiology-treatment-options

  These stones are not able to be dissolved with medical treatment and diet modification, so they usually require removal or circumvention using traditional or minimally invasive surgical techniques. Medical management to dislodge the obstruction can be attempted but this should be given a finite period of time before choosing a surgical method of correction. […] Ureteral stents are poorly tolerated in cats, causing dysuria due to irritation of the trigone (McLauchlan, 2020). Due to this, a subcutaneous ureteral bypass (SUB) device was designed by Norfolk Vet Products in 2009. […] The mortality rate for SUB device placement is considerably lower than ureterotomy (10 percent compared to 25 percent). […] Regular flushing of the device with ultrasound guidance is recommended long-term and it is important to make the owner aware of this continued commitment, both financially and personally, prior to carrying out the procedure.

• #45 18 | How to successfully care for cats with ureteral obstructions — Veterinary Internal Medicine Nursing

  https://www.veterinaryinternalmedicinenursing.com/blog/episode-18

  After the patient is discharged, our care does not end. These patients require regular reassessments to evaluate their renal function and maintain the SUB device. SUBs are not without complications, and things like obstruction, mineralisation, infection and displacement or fracture of the device are all reported – so we need to regularly check the patency of the device and collect urine samples from it to check for infection.

• #46 Obstructive Uropathy – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/obstructive-uropathy/obstructive-uropathy

  Definitive treatment depends on the etiology and consists of eliminating the obstruction by surgery, instrumentation (eg, endoscopy, lithotripsy), or medication therapy (eg, hormonal therapy for prostate cancer). […] Prompt drainage of hydronephrosis is indicated if renal function is compromised, urinary tract infection (UTI) persists, or pain is uncontrollable or persistent. […] Immediate drainage is indicated if obstruction is accompanied by infection. […] Initial management of lower obstructive uropathy involves assessment of urethral patency with prompt and complete bladder decompression by catheterization or more proximal drainage. […] Indwelling ureteral catheters can be placed for acute or long-term drainage in selected patients. […] Temporary drainage using a percutaneous nephrostomy technique may be needed in severe obstructive uropathy, UTI, or calculi, especially when a ureteral stent cannot be placed into the collecting system.

• #47 Ureteral Obstruction | UMass Memorial Health

  https://www.ummhealth.org/services-treatments/urology/uteteral-obstruction

  Nephrostomy: We make a small opening in your back and insert a catheter (flexible tube) to drain urine directly from your kidneys into an external pouch. […] We use evidence-based techniques offering a more permanent solution to lower your risk of future blockages. […] Urologists at UMass Memorial Medical Center routinely diagnose and treat ureteral obstructions and strictures resulting from kidney transplantation, advanced cancer and gynecological or abdominal surgeries. […] Urologists, nephrologists (kidney specialists) and interventional radiologists at UMass Memorial work together to treat urinary tract disorders such as ureteral obstructions. […] Experts at UMass Memorial Medical Center frequently use endoscopic and robotic-assisted methods. Endoscopic procedures involve sliding tiny instruments through the urethra instead of an incision. Robotic urologic surgery uses specialized technologies to enhance the reach and precision of the urologists hands. Both methods help you recover faster and with less pain.

• #48 Ureteral Obstruction: Understand Causes, Symptoms, & Treatment Options | Max Hospital

  https://www.maxhealthcare.in/blogs/ureteral-obstruction

  Surgery is required when the obstruction is due to large kidney stones, tumors, scar tissue, or congenital abnormalities. […] Surgical treatment is usually recommended if the blockage is severe or complete. […] Ureteral obstruction is a serious condition that requires timely diagnosis and treatment. If left untreated, the blockage can worsen over time, leading to severe complications that may permanently damage the kidneys and affect overall health.

• #49 Ureteral obstruction | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20208697/

  Ureteral obstruction can be cured. However, if its not treated, symptoms can quickly move from mild pain, fever and infection to severe loss of kidney function, sepsis and death. […] The goal of ureteral obstruction treatment is to remove blockages, if possible, or bypass the blockage, which may help repair damage to the kidneys. Treatment might include antibiotics to clear associated infections. […] A ureteral obstruction that causes severe pain might require an immediate procedure to remove urine from your body and temporarily relieve the problems caused by a blockage. Your doctor (urologist) may recommend: A ureteral stent, which is a hollow tube inserted inside the ureter to keep it open. […] There are a number of surgical procedures used to correct ureteral obstructions. The type of procedure depends on your situation.

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