A narrowing anywhere in the ureter. Obstruction of urine flow results in increased urinary tract pressures, and dilation of these systems with eventual renal damage.

Common causes of ureteral stricture are congenital or acquired. Narrowing and stricture at the junctions where the ureters join the kidneys or the bladder are the places congenital obstruction often occurs. Acquired defects are calculi, tumors, infections, and structural narrowing.

Pain from rapid distention in the system is notable. Pain is minimal with slowly developing obstruction. Renal colic is the result of a stone lodged in a ureter and it is described as excruciating. The pain begins in the flank and radiates to the genital area. There may be evidence of distention of the kidney or the bladder.

Abdominal ultrasound is usually the first choice for testing most patients. Regular x-rays, and computed tomography (CT) scan are also helpful in the diagnosis of obstruction. Urinalysis may reveal blood, pus, bacteria, and sediment in the urine.

The composition of stones should be analyzed because treatment varies with the type of stone. Relief of obstruction as quickly as possible is mandatory to prevent renal damage. Use of an endoscope (instrument to see inside the ureter and grasp the stone), lithotripter (creates shock waves to break up a stone), or open surgery may be used to treat the condition. Every patient should be taught to drink enough water so that they urinate at least 2 liters a day.

Most patients with stones have treatable metabolic disorders. Calcium stone formation can be reduced by 50% by administration of thiazide diuretics as long as drug-induced hypokalemia is treated. Urinary tract infections (UTI) are also complications of obstruction, and need immediate treatment.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See 38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• The new criteria for the Genitourinary Disease and Conditions body system became effective November 14, 2021.  Review both current and historic criteria prior to any reduction for disabilities established before that date. 

• When evaluating any claim involving loss or loss of use of one or more creative organs, refer to 38 CFR 3.350 of this chapter to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.