NCLEX Review Guide: Ureteritis

Definition and Causes

• Ureteritis is inflammation of the ureter, typically caused by ascending bacterial infection from the bladder or descending infection from the kidneys. Most commonly occurs as a complication of untreated UTI or urinary obstruction.
• Primary causes include E. coli, Proteus, Klebsiella, and Enterococcus, with risk factors including urinary stasis, kidney stones, pregnancy, and immunocompromised states.

Clinical Manifestations

• Classic triad: flank pain, dysuria, and urinary frequency with pain radiating from costovertebral angle to lower abdomen and groin area.
• Systemic symptoms include fever, chills, nausea, vomiting, and malaise, often indicating progression to pyelonephritis or sepsis.

Diagnostic Tests

• Urinalysis and urine culture show pyuria, bacteriuria, hematuria, and positive nitrites/leukocyte esterase with bacterial count >100,000 CFU/mL indicating infection.
• Imaging studies include CT urogram or IVP to identify obstruction, stones, or anatomical abnormalities contributing to ureteritis.

Treatment Interventions

1. Administer prescribed antibiotics based on culture sensitivity, typically fluoroquinolones or trimethoprim-sulfamethoxazole for 7-14 days
2. Provide pain management with analgesics and antispasmodics like phenazopyridine for urinary tract anesthesia
3. Encourage increased fluid intake (2-3 L/day unless contraindicated) to promote bacterial washout and prevent stone formation
4. Monitor for complications including sepsis, abscess formation, or chronic pyelonephritis