Obstructive Uropathy
What is it?
Obstructive uropathy is when
there is a blockage of the flow of urine out of
the bladder and urethra, which may result in urine
backing up into the kidneys. This can cause damage
to the kidneys.
Who gets it and what are the
causes?
Obstructive uropathy can occur
in men or in women. Men usually get a blockage
caused by an enlarged prostate. In women, it is
much less common, but can be caused by a condition
known as bladder cystocele. Other causes can be
bladder tumors, tumors of the prostate, and tumors
or other structures around the bladder neck or
urethra. It can also be a result of strictures in
any part of the urinary tract. Kidney stones or
bladder stones can also cause the obstructions.
What are its symptoms?
The symptoms of obstructive
uropathy include a decreased urine output, urinary
hesitancy, or abnormal urine flow—dribbling at
the end of voiding. It can cause incontinence, or
inability to control the urine flow. The patient
may notice a decrease in the force of the urinary
stream, or a small, weak stream. He or she may
notice urinary frequency and increased urgency,
along with a need to urinate at night. There may
be a frequent strong urge to urinate. Burning or
stinging with urination can also be a symptom.
There may be flank pain or pain in the sides that
is on both sides and begins suddenly. The patient
may have blood in the urine, or an abnormal color
to the urine. A recent sudden increase in the
blood pressure can also by a symptom.
Diagnosis
Abdominal examination
frequently will show enlarged and tender kidneys.
Palpation of the bladder shows distention of the
bladder. If the blockage is between the bladder
and the urethra, placing a catheter may relieve
the obstruction, and lack of urine output. If the
blockage is before the bladder, placement of a
catheter will result in little or no urine output.
Several laboratory studies can
help in diagnosing this condition. A urinalysis
may be abnormal. The urine may show signs of an
infection in the urinary tract. Blood tests called
the BUN and creatinine may increase suddenly over
a two week period. These indicate that the kidneys
are not working as they are supposed to, and can
indicate the beginning of damage to the kidneys.
The excretion of creatinine in the urine, or
creatinine clearance, may be decreased. Serum
potassium may be elevated because it cannot be
excreted adequately by the kidneys. Blood
chemistries and a test called arterial blood gas
may show a condition known as metabolic acidosis,
or a build up of acids in the blood because the
kidneys are not functioning correctly.
There are also radiologic
studies that can indicate a blockage. They will
show a condition known at hydronephrosis, or
kidneys that are overfilled with fluid. This is
caused by the urine backing up to the kidneys due
to the blockage. The tests that indicate
hydronephrosis are and intravenous pyelogram, a
renal scan, and ultrasound of the kidneys, and an
abdominal CT scan.
Treatment
Treatment is based on relieving
the cause of the obstruction, which will allow the
urine to drain from the kidneys and eventually
from the body. Catheterization can be a short term
treatment. They may leave the catheter in place
initially, or they may have the patient learn
intermittent catheterization.
Surgical Treatment
Long term relief of the
condition can be treated only by relieving the
cause of the obstruction. If it is because of
prostate enlargement or cancer, surgical reduction
of the prostate can be done. Other blockages can
also be surgically corrected. A stent can be
placed in the ureter, the tube that drains urine
from the kidney to the bladder. This allows the
urine to flow past the blocked portion, or allows
a kidney stone to pass. The kidney stone may need
to be surgically removed through cytoscopy, or it
may be broken up with sound waves and a procedure
called lithotripsy.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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