Obstructive uropathy is a blockage of the normal flow of urine somewhere along the urinary tract.
The urinary tract consists of the kidneys, the ureters (tubes connecting the kidneys to the bladder), the bladder, and the urethra, the tube through which a person empties the bladder during urination. Obstruction can occur anywhere along this tract. Obstruction of urine flow increases the pressure to the kidney and can result in acute renal failure.
Symptoms of obstructive uropathy include: flank paingroin painblood in the urinepain above the pubic bonetenderness, feeling of fullness, or a mass in the lower abdomenincreased or decreased urinationdifficulty urinating or inability to urinateincreased frequency and urgency of urinationrecurrent urinary tract infectionsinability to control the flow of urine
Obstructive uropathy may be caused by: kidney stonesurethral strictures, or narrowing of the urethrapressure from nearby tumorsscarring from previous radiation therapyurinary tract infectioncancerneuromuscular disorders, such as diabetic neuropathy
Obstructive uropathy is more common in a person with: sickle cell anemiadiabetes mellitusneuromuscular diseasepregnancycancerbenign prostatic hyperplasia (BPH)history of kidney stoneshistory of radiation therapyuterine prolapsecertain congenital disorders that affect the urinary tract
The history, a physical exam, and lab tests help in diagnosing the condition. X-rays may be taken to look for kidney stones. Ultrasound may show swelling of the kidneys and enlargement of the renal collection system, called hydronephrosis. If the obstruction is lower, it may show enlargement of the ureters, called hydroureter.
If the ultrasound does not show an obstruction, an intravenous pyelogram may be done. This test shows how the urine flows throughout the urinary tract. A contrast agent is injected into a blood vessel and is quickly excreted into the urine. Multiple x-rays are taken to show the flow of urine from the kidneys to the bladder. An obstruction shows up as a blockage of this flow. Retrograde pyelograms are similar. They show the flow of urine from the kidney to the urethra.
Treatment focuses on relieving the obstruction with surgery, bypass, or medications.
If the cause is benign prostatic hyperplasia, that condition is treated. BPH can be treated with medications, intermittent or continuous use of a urinary catheter in the bladder, or prostate surgery.
If the obstruction is at a higher level, two kinds of tubes can be used to bypass it. A catheter can be placed in the bladder, or a tube is placed through the skin close to the obstructed ureter. Other surgical procedures include redirecting the ureters or placing stents in them.
Any urinary catheterization increases the risk of urinary tract infections. Surgery can be complicated by infection, bleeding, or reactions to the anesthesia.
Recovery of kidney function often depends on how long the obstruction lasts. If it is less than 7 days, recovery is usually complete. If it is less than 2 weeks, the chance of renal recovery is about 70%. Obstruction that lasts up to 30 days has only a 30% chance of renal recovery. After 2 to 3 months of obstruction, renal recovery is unlikely. Some people continue to have kidney problems for a long period of time after obstruction.
The individual needs to make periodic visits to the healthcare provider to monitor kidney function. Any new or worsening symptoms should be reported.
