Urinary Tract Obstruction

Urinary tract obstruction is a condition where urine flow is blocked along the urinary tract, causing a backup of urine within the kidneys, resulting in severe pain, possible infection, and, eventually, the possibility of kidney damage. This can happen at several places along the urinary tract, including the ureters, bladder, or urethra. Congenital urinary tract obstruction, which is present at birth, is caused by a problem in the development of the urinary tract, and it is the number one cause of chronic kidney disease in children.1

Symptoms

  • Difficulty urinating (urinary hesitancy) or a weak urine stream.
  • Abdominal or flank pain (located in the lower back and side below the rib cage).
  • Recurrent urinary tract infections (UTIs).
  • Blood in urine (hematuria).

Diagnosis

To diagnose urinary tract obstruction, your doctor will obtain a complete medical history and physical examination of your child.. Imaging studies such as ultrasound, CT scan, MRI, and voiding cystourethrogram (a specialized x-ray of the bladder that monitors how a bladder empties) may be ordered to look for the cause of the obstruction. Diagnosis of urinary tract obstruction is more straightforward following birth, but it can even be discovered in utero.

Treatment

Conservative Management

Antibiotics will be prescribed for any infections (such as UTIs). Medications (prescription or over-the-counter) may be prescribed to relieve discomfort and other symptoms.

Surgical Intervention

  • In cases of ureteropelvic junction obstruction, pyeloplasty removes the blocked part of the ureter (the tube that connects the kidney to the bladder).
  • With ureterovesical junction obstruction, a ureteral reimplantation may be performed to change the position of the ureter’s connection to the bladder.
  • Endoscopic procedures can remove obstructions or relieve strictures (narrowing). Endoscopies use a straw-like tube with a scope (camera) on the end to travel through the body’s natural urinary system rather than cuts in the skin to reach surgical areas.

Follow-Up

No matter the severity of the obstruction or treatment method, your child will require regular follow-ups to monitor kidney function and watch for infections.

Resource:

  1. Chevalier RL. Congenital Urinary Tract Obstruction: The Long View. Advances in Chronic Kidney Disease. 2015;22(4):312-319. doi:https://doi.org/10.1053/j.ackd.2015.01.012