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Urology/Ureteric block

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Question
I am 65 yrs of age male. I had  a stone at right pelviureteric  junction with mild hydronephrosis 5 yrs back. It was removed by laser lithotripsy.Again there was recurrence of stone in the same location 1 yr back and again removed by laser lithotripsy.
I month back due to some urinary problem (urge incontinence,pain in the right loin  for 2 consecutve days relieved by antispasmodic) I did USG of right kidney,ureter ,bladder. It showed  a  ? stone of 10mm size at right ureterovescical  junction but  x-ray showed nothing.I did IVU and it showed a block at the lower end of right ureter with dilatation of ureter,hydroneprosis and perfusion of rt.kidney only after 2 hrs.
Urologist did uteroscopy but found no stone or stricture and gave a D.J. stent. As cause of this block could not be ascertained ,whether there will be again block in the same site?
What might be the cause of this block?

Answer
Shekhar:

If there is no stone or stricture, the most common cause of a block in this area would be functional.  This means that although the passage is actually open, there is a disruption of the neuromuscular function at this point.  Unfortunately, there is no good simple treatment for this.  If things continue to worsen or appear to cause renal damage, it may become necessary to consider a surgical excision of this damaged portion of the ureter if possible.

You should also inquire about a 24 hour urine test for kidney stone prevention testing and treatment to minimize you're future stone risk.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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