At Providence Saint John’s Health Center, our urology specialists provide personalized treatment for urinary obstruction and conditions requiring reconstruction of the urinary tract. Our goal is to restore normal urine flow, protect kidney function and, when reconstruction is needed, use minimally invasive and advanced surgical techniques tailored to each patient’s anatomy and condition.
What Is Urinary Obstruction?
Urinary obstruction occurs when urine cannot flow normally through part of the urinary tract. When an obstruction affects a ureter—the tube that carries urine from a kidney to the bladder—urine can back up toward the kidney, potentially causing pain, infection, kidney stones or loss of kidney function. Urologic reconstruction includes surgical techniques used to repair damaged or narrowed portions of the urinary tract and restore normal drainage.
What Is a Ureteral Stricture?
A ureteral stricture is an abnormal narrowing of a ureter. Scar tissue, inflammation, injury or other conditions can reduce the diameter of the ureter and prevent urine from draining normally from the kidney. The severity of an obstruction and its effect on kidney function help determine whether treatment is needed.
What Causes a Ureteral Stricture?
Ureteral strictures can develop after an injury or inflammation causes scar tissue to form within or around the ureter. In some patients, the narrowing develops after a previous procedure or treatment, while others may have an underlying medical or congenital condition.
- Previous surgery or injury involving the ureter
- Kidney stones or procedures used to treat kidney stones
- Inflammation or infection involving the upper urinary tract
- Radiation therapy involving the urinary tract or surrounding tissues
- Tumors involving or compressing the ureter
- Conditions such as endometriosis that can affect tissues surrounding the ureter
- Congenital abnormalities present from birth
- Other inflammatory or scarring conditions
Symptoms of Ureteral Obstruction
Symptoms depend on the location, severity and duration of the obstruction. Some slowly developing obstructions may initially cause few or no symptoms, while more significant blockage can cause pain or complications involving the affected kidney.
- Side, flank or back pain
- Blood in the urine
- Nausea or vomiting with significant obstruction
- Recurrent urinary tract or kidney infections
- Kidney stones
- Changes in kidney function
How Is Ureteral Obstruction Diagnosed?
Evaluation is designed to identify where the urinary tract is narrowed, determine the cause and measure how the obstruction is affecting kidney drainage and function. The tests used depend on the patient’s symptoms, medical history and previous procedures.
Ultrasound, CT and MRI
Imaging can reveal swelling of the kidney, narrowing of the ureter, stones, masses or other abnormalities that may interfere with urine flow. Ultrasound, CT or MRI may be used depending on the clinical situation and the anatomical detail needed.
Renal Nuclear Medicine Scan
A nuclear renal scan can provide information that anatomical imaging alone cannot. It can help physicians determine how well each kidney functions and how effectively urine drains from the kidney through the ureter, which can be particularly useful when deciding whether an obstruction requires treatment.
Retrograde Pyelography and Ureteroscopy
When more detailed evaluation is needed, retrograde pyelography can outline the ureter using contrast material introduced through the urinary tract. Ureteroscopy allows the urologist to directly examine the inside of the ureter with a small camera. These procedures can help define the location and extent of a stricture and guide treatment planning.
What Is Ureteropelvic Junction Obstruction?
Ureteropelvic junction (UPJ) obstruction occurs where the renal pelvis—the part of the kidney that collects urine—connects with the ureter. Narrowing or compression at this junction can interfere with drainage, causing urine to accumulate within the kidney and potentially affect kidney function.
What Causes UPJ Obstruction?
UPJ obstruction is often related to an anatomical condition that has been present since birth but may not cause symptoms until later in life. It can also develop or become symptomatic because of changes affecting the junction between the kidney and ureter.
- Congenital narrowing or abnormal development of the UPJ
- A blood vessel that crosses the ureter and contributes to compression or impaired drainage
- Scar tissue involving the UPJ
- Kidney stones or previous stone treatment
- Previous procedures involving the kidney or ureter
- Other conditions that narrow or obstruct urine flow
Symptoms of UPJ Obstruction
Some patients have no symptoms and are diagnosed after imaging reveals swelling of the kidney. Others develop symptoms when impaired drainage increases pressure within the kidney or contributes to infection or stone formation.
- Flank, side or back pain
- Nausea or vomiting
- Blood in the urine
- Urinary tract or kidney infections
- Kidney stones
- Declining function of the affected kidney in more significant cases
How Is UPJ Obstruction Diagnosed?
Imaging such as ultrasound or CT can show enlargement of the kidney and provide information about the anatomy of the urinary tract. Blood and urine testing may also be used to evaluate kidney function and look for infection or other abnormalities.
A nuclear renal scan can be particularly helpful because it measures how well each kidney functions and how effectively urine drains from the affected kidney. This allows the urologist to distinguish anatomical dilation from functionally significant obstruction and helps determine whether treatment is necessary.
How Is Urinary Obstruction Treated?
Treatment depends on where the obstruction is located, what caused it, how severely urine flow is restricted and whether kidney function is threatened. Some patients need temporary drainage of the affected kidney, while others benefit from surgical reconstruction designed to provide a durable repair and restore normal urinary flow.
Restoring Urinary Drainage
When an obstruction is causing significant pain, infection or impaired kidney function, restoring drainage may be the immediate priority. A ureteral stent can be placed within the ureter to help keep urine flowing, while a nephrostomy tube can provide drainage directly from the kidney when needed. These approaches may be temporary while the cause of the obstruction is evaluated or a definitive repair is planned.
Reconstruction for Ureteral Stricture
When a ureteral stricture requires definitive repair, the reconstructive approach depends on the location and length of the narrowed segment and the condition of the surrounding urinary tract. Surgery may involve removing scarred tissue and reconnecting healthy portions of the ureter, reconnecting the ureter to the bladder or using other reconstructive techniques when a longer or more complex segment must be repaired.
The goal is to create a durable pathway for urine to drain from the kidney while preserving kidney function whenever possible. A temporary ureteral stent may be used during healing to support the reconstructed area and is removed according to the patient’s postoperative plan.
Robotic and Minimally Invasive Reconstruction
Robotic and other minimally invasive techniques may allow surgeons to perform delicate urinary reconstruction through small incisions. A magnified surgical view and articulated instruments can be particularly useful when removing scarred tissue and reconnecting small urinary structures.
Not every reconstruction is best performed robotically. The surgical approach is selected according to the location and complexity of the obstruction, previous surgery or radiation, surrounding tissue and the type of reconstruction required.
Explore Robotic Urologic Reconstruction.
Treatment of UPJ Obstruction
Treatment is considered when UPJ obstruction causes symptoms, recurrent infection or stones, or threatens function of the affected kidney. For patients who require definitive surgical repair, pyeloplasty reconstructs the junction between the renal pelvis and ureter so urine can drain more freely from the kidney.
Robotic Pyeloplasty
During pyeloplasty, the narrowed or obstructed portion of the ureteropelvic junction is removed or reconstructed and the healthy ureter is reconnected to the renal pelvis. When a crossing blood vessel contributes to the obstruction, the reconstruction can also reposition the urinary connection to relieve compression.
Pyeloplasty can often be performed using robotic or laparoscopic techniques, although the appropriate approach depends on the patient’s anatomy and previous treatment. A temporary ureteral stent is commonly placed to support drainage while the reconstructed area heals and is removed later according to the surgeon’s treatment plan.
Recovery and Follow-Up
Recovery varies according to the surgical approach, the complexity of the repair and the patient’s overall health. Follow-up may include removal of the ureteral stent and imaging or functional testing to confirm that the kidney is draining appropriately after reconstruction.
Urinary Reconstruction After Bladder Removal
Urologic reconstruction is also an important part of treatment when bladder cancer requires removal of the bladder, a procedure called radical cystectomy. Because the kidneys continue to produce urine after the bladder is removed, the surgeon creates a new way for urine to be stored or carried out of the body. The appropriate type of urinary diversion depends on the cancer, anatomy, kidney function, overall health and the patient’s individual priorities.
Neobladder
A neobladder is an internal reservoir constructed from a segment of intestine and connected to the urethra. It allows urine to leave the body through the urethra rather than through an external collection pouch.
Urination with a neobladder differs from normal bladder function, and patients must learn how to empty the new reservoir effectively. Some patients may experience leakage or difficulty emptying and may occasionally or regularly need a catheter. The care team discusses these considerations before surgery so patients understand the functional changes associated with reconstruction.
Ileal Conduit
An ileal conduit uses a short segment of intestine to create a pathway that carries urine from the ureters to a small opening in the abdomen called a stoma. Urine drains continuously through the stoma into an external collection pouch worn on the abdomen.
An ileal conduit does not store urine inside the body. Patients receive education about caring for the stoma and collection system as part of preparation and recovery after surgery.
Continent Cutaneous Urinary Diversion
A continent cutaneous diversion creates an internal reservoir from intestinal tissue but does not connect it to the urethra. Instead, the reservoir connects to a small opening in the abdomen and is emptied periodically using a catheter.
An Indiana pouch is one type of continent cutaneous urinary diversion. Whether this or another form of reconstruction is appropriate depends on the patient’s anatomy, kidney function, cancer treatment and ability to manage the diversion safely over time.
Choosing the Right Type of Urinary Reconstruction
There is no single reconstruction that is best for every patient. The decision considers cancer treatment requirements along with kidney function, previous abdominal or pelvic treatment, other medical conditions, lifestyle and the patient’s preferences regarding urinary function and long-term care.
Patients undergoing bladder removal can learn more about the cancer itself, radical cystectomy and treatment planning on our Bladder Cancer page.
Personalized Urologic Reconstruction at Saint John’s
At Providence Saint John’s Health Center, our urology specialists evaluate both the cause of urinary dysfunction and its effect on the kidneys and urinary tract. When reconstruction is needed, treatment is planned to restore urinary drainage and function while preserving healthy tissue and kidney function whenever clinically appropriate.
If you have been diagnosed with urinary obstruction, ureteral stricture or UPJ obstruction, or need urinary reconstruction following treatment, our urology specialists can help determine the appropriate next steps.
If you have questions regarding urinary obstruction or treatments, please call today, or Click Here to make an appointment.
