ENLmedical.com: Conditions And Concerns: Medical Encyclopedia: Chronic bilateral obstructive uropathy

Chronic bilateral obstructive uropathy

Causes and Risks:
Obstructive uropathy occurs when the flow of urine is blocked. The kidneys produce urine in the normal manner but the urine cannot leave the bladder because of an obstruction. Urine may back up behind the obstruction and damage the structures of the urinary tract.

When the obstruction is located so that urine backs up into both kidneys, the damage results in hydronephrosis (distention of the kidney pelvis and calyces) and bilateral obstructive uropathy (damage to both kidneys caused by obstruction of urine). Obstructive uropathy can eventually lead to hypertension and/or renal failure . Sudden blockage causes acute bilateral obstructive uropathy , while slow progressive blockage causes chronic bilateral obstructive uropathy.

Chronic bilateral obstructive uropathy is caused by gradual obstruction of both ureters or the bladder or urethra, resulting in a back-up of urine into both kidneys. In men, this is most often as a result of a benign enlargement of the prostate. It is much less common in women, but can occur as a result of bladder cystocele .

Other causes include bladder tumors, prostate tumors, and tumors or masses (aggregations of cells) of the uterus or other structures around the bladder neck or urethra, including retroperitoneal fibrosis . Narrowing of the urethra may be caused by congenital deformity or scar tissue from injury or infection.

Initially, the bladder reacts to the obstruction by increased irritability. There is a stronger and more frequent urge to urinate , and bladder spasms or incontinence may occur. As urine accumulates, it may lead to stasis of urine and urinary tract infections . Urine backs up into the ureters and kidneys. Symptoms are the result of urinary retention and damage to the bladder, ureters, and kidneys.

Chronic bilateral obstructive uropathy occurs in about 1 out of 1,000 people.

Prevention:
Routine rectal examination in men may show the enlarged prostate before it becomes large enough to obstruct the urethra.

Symptoms:

stronger and more frequent urge to urinate
difficulty initiating the flow of urine ( urinary hesitancy )
dribbling of urine, incontinence
decrease in the force of the urinary stream, stream small and weak
need to urinate at night
burning or stinging with urination
feeling of incomplete emptying of the bladder
alternating episodes of increased urine output and decreased urine output
fever and chills (if there is also urinary infection)

Additional symptoms that may be associated with this disease:

Signs and Tests:
Examination of the abdomen by touch may show enlarged or tender kidneys. Rectal examination may reveal enlarged prostate. Signs and symptoms of chronic renal failure may be present. The blood pressure may be elevated.

A urinalysis and a urine culture (clean catch) may show a urinary tract infection .
A CBC may show leukocytosis (increased white blood cell count ) if there is urinary tract infection or septicemia .
A voiding cystourethrogram (VCUG) shows significant post void residual (more than 50 ml. urine remains in the bladder after urinating).

Hydronephrosis (distention of the renal pelvis and calyces) may be apparent on:

Treatment:
The initial treatment focuses on relieving urinary retention.

Catheterization may provide short-term relief. This may be an indwelling urinary catheter or it may involve intermittent catheterization.

Surgical reduction of the prostate, such as by a TURP ( transurethral resection of the prostate ) provides correction of enlarged prostate. Other surgical intervention may be appropriate for other disorders causing obstruction of the urethra or bladder neck.

Antibiotics may be needed to treat urinary tract infection . Treatment for chronic renal failure may be necessary.

Prognosis:
If the obstruction is corrected before the development of renal failure , chronic bilateral obstructive uropathy may be cured. If chronic renal failure develops, The probable outcome is much poorer. If the obstruction was caused by a cancer , the outcome is determined by the extent of residual tumor after treatment.

Complications:

Call Your Healthcare Provider:
Call for an appointment with your health care provider if decreased urine output or other symptoms of chronic bilateral obstructive uropathy develop.

A catheter (a hollow tube, often with an inflatable balloon tip) may be inserted into the urinary bladder when there is a urinary obstruction, following surgical procedures to the urethra, in unconscious patients (due to surgical anesthesia, coma, etc.), or for any other problem in which the bladder needs to be kept empty (decompressed) and urinary flow assured.

Catheterization is accomplished by inserting a catheter (a hollow tube, often with and inflatable balloon tip) into the urinary bladder. This procedure is performed for urinary obstruction, following surgical procedures to the urethra, in unconscious patients (due to surgical anesthesia, coma, etc.), or for any other problem in which the bladder needs to be kept empty (decompressed) and urinary flow assured. Catheterization in males is slightly more difficult and uncomfortable than in females because of the longer urethra.