Ureteral Compression: Symptoms, Diagnosis, and Treatment Options

Ureteral compression

Hello, about two months ago, I felt a strain in my lower back that persisted several times until early March when one night I suddenly experienced back pain so severe that I couldn't lie flat to sleep; even side sleeping was impossible, and I could only curl up to feel somewhat better.
Recently, I visited a urologist and underwent an endoscopic examination, which revealed left kidney hydronephrosis, and a double-J stent was placed.
A subsequent CT scan showed an unknown mass approximately 2 cm in size located at the 3/1 junction of the left ureter, compressing it.
A biopsy was performed, and the results were benign; however, I still experience pain in my left abdomen, lower back discomfort, and unease radiating from my left groin to the inner thigh.
I would like to know how to proceed—should I wait and see if the situation changes over time, or should I consult another specialty? Thank you!

YY, 60~69 year old female. Ask Date: 2020/04/17

Dr. Chen Jiansheng reply Urology

If the pain is caused by hydronephrosis, it should be alleviated after the drainage tube is placed.
Please return for a follow-up appointment and inform the physician that your symptoms have not improved.
Investigate whether there are other potential causes of the pain or if it is simply discomfort caused by the tube.

Reply Date: 2020/04/17

More Info

Understanding ureteral compression is crucial for diagnosing and managing the associated symptoms effectively. Ureteral compression can occur due to various reasons, including the presence of stones, tumors, or other masses that exert pressure on the ureter, leading to obstruction and subsequent complications.

Symptoms of Ureteral Compression
The symptoms you are experiencing, such as persistent lower abdominal pain, back pain, and discomfort radiating to the groin and inner thigh, are common indicators of ureteral obstruction. Other symptoms may include:
- Flank Pain: Pain on the side of the body, often severe and sharp.

- Nausea and Vomiting: Due to the body's response to pain and obstruction.

- Changes in Urination: This can include increased frequency, urgency, or pain during urination.

- Hematuria: Blood in the urine, which may occur if there is irritation or injury to the urinary tract.

Diagnosis
In your case, the diagnosis has already been initiated with imaging studies such as a CT scan, which revealed a mass compressing the ureter. The presence of a double-J stent indicates that there was a need to relieve the obstruction and allow urine to flow from the kidney to the bladder. This is a common procedure in cases of ureteral obstruction.

Treatment Options
1. Observation: If the mass is benign and not causing significant symptoms, a watchful waiting approach may be appropriate. Regular follow-ups with imaging studies can help monitor any changes in the size or nature of the mass.

2. Surgical Intervention: If the mass is causing significant symptoms or if there is a risk of kidney damage, surgical options may be considered. This could involve:
- Ureteroscopy: A minimally invasive procedure to remove stones or masses directly.

- Laparoscopic Surgery: For larger masses or tumors, a laparoscopic approach may be used to remove the obstruction.

- Open Surgery: In some cases, traditional open surgery may be necessary, especially if the mass is large or involves complex anatomical structures.

3. Pain Management: Given your ongoing discomfort, pain management strategies should be discussed with your healthcare provider. This may include medications such as NSAIDs or other analgesics.

4. Referral to Specialists: Depending on the nature of the mass, you may benefit from consultations with other specialists, such as a urologist or an oncologist, especially if there is any concern regarding malignancy.

Conclusion
It is essential to maintain open communication with your healthcare team regarding your symptoms and any changes you experience. Given the complexity of your situation, a multidisciplinary approach may be beneficial. Regular follow-ups and imaging studies will help ensure that any changes in your condition are promptly addressed. If your symptoms worsen or new symptoms arise, do not hesitate to seek immediate medical attention. Your health and comfort are paramount, and proactive management is key to addressing ureteral compression effectively.

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