Acute bilateral obstructive uropathy

• Alternative Names

  Urethral obstruction; Acute urethral obstruction; Obstructive uropathy - bilateral - acute

• Causes, incidence, and risk factors

  In men, acute bilateral obstructive uropathy is most often a result of an enlarged prostate. Other causes in men include:

  • Bladder cancer
  • Kidney stones
  • Prostate cancer

  Acute bilateral obstructive uropathy is much less common in women, but may be due to:

  • Bladder cystocele
  • Cervical cancer
  • Injury from surgery involving the reproductive organs
  • Pregnancy

  Other causes in men and women include:

  • Blood clots
  • Neurogenic bladder
  • Other rare retroperitoneal processes
  • Papillary necrosis
  • Posterior urethral valves in infant boys

  Acute bilateral obstructive uropathy occurs in about 5 out of 10,000 people.

• Symptoms
  • Abnormal urine flow -- dribbling at the end of urination
  • Blood in the urine
  • Burning or stinging with urination
  • Decrease in the force of the urinary stream, stream small and weak
  • Decreased urine output (may be less than 10 mL per day)
  • Feeling of incomplete emptying of the bladder
  • Fever
  • Frequent strong urge to urinate
  • Recent increase in blood pressure
  • Leakage of urine (incontinence)
  • Nausea and vomiting
  • Need to urinate at night
  • Sudden flank pain or pain on both sides
  • Urinary hesitancy
  • Urine, abnormal color
• Signs and tests

  The doctor will perform a physical exam. The exam may show:

  • Large and full bladder
  • Swollen or tender kidneys
  • Enlarged prostate (men)

  There may be signs of chronic kidney failure, high blood pressure, and infection. Fever is common with an infection.

  Tests that may be done include:

  • Arterial blood gas and blood chemistries
  • Basic metabolic panel -- will reveal kidney function and electrolyte balance
  • Blood BUN
  • Creatinine clearance
  • Complete blood count
  • Potassium test
  • Serum creatinine test
  • Urinalysis and a urine culture (clean catch)
  • Ultrasound of the bladder
  • Uroflowmetry

  The following tests may show hydronephrosis (swelling of kidneys):

  • IVP
  • Renal scan
  • Ultrasound of the kidneys
  • Abdominal CT scan

  This disease may also alter the results of the following tests:

  • Creatinine - urine
  • Radionuclide cystogram
• Treatment

  The goal of treatment is to relieve the blockage, which will allow urine to drain from the urinary tract. You may need to stay in a hospital for a short while.

  Short-term treatment may include:

  • Antibiotics and other medications to treat symptoms
  • Catheterization-- the placement of a tube into the body to drain urine (See: Urinary catheters)

  Long-term treatment involves correcting the cause of the blockage. This may involve:

  • Surgery such as transurethral resection of the prostate (TURP)
  • Laser or heat therapy to shrink the prostate if the problem is due to an enlarged prostate

  Surgery may also be needed for other disorders that cause blockage of the urethra or bladder neck.

• Expectations (prognosis)

  If the acute obstruction is quickly relieved, symptoms usually go away within hours to days. If untreated, the disorder causes progressive damage to the kidneys. It may eventually lead to high blood pressure or kidney failure.

• Complications
  • Acute kidney failure
  • Chronic bilateral obstructive uropathy
  • High blood pressure
  • Reflux nephropathy
  • Urinary tract infection
  • Urinary retention or incontinence
• Calling your health care provider

  Call your health care provider if you have decreased urine output, difficulty urinating, flank pain, or other symptoms of acute bilateral obstructive uropathy.

• Prevention

  You may not be able to prevent this condition. Routine annual physicals with a primary care doctor are recommended. If your doctor finds you have acute obstructive uropathy, you should be referred to the nearest emergency room and seen by a urologist.

• References

  Wein AJ, et al. Campbell-Walsh Urology. 9th ed. St. Louis, Mo: WB Saunders; 2007.

  Goldman L, Ausiello D, et al. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa: WB Saunders; 2004:741-742.

Review Date: 1/24/2008

Reviewed By: Marc A. Greenstein, D.O., F.A.C.O.S. Urologist, Somerset Medical Center in Somerville, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.