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

Acute 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 does not drain properly because of an obstruction. Pressure in the urinary tract rises, resulting 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 acute renal failure . Sudden blockage causes acute bilateral obstructive uropathy, while slow progressive blockage causes chronic bilateral obstructive uropathy .

Acute bilateral obstructive uropathy is caused by obstruction of the urethra that occurs suddenly or over a short time. In men, it is most often a result of an enlarged prostate. It is much less common in women but can occur as a result of bladder cystocele . Other causes include bladder tumors, tumors of the prostate (see prostate cancer ), and tumors or other structures around the bladder neck or urethra, especially if the tumors grow quickly and by strictures in any part of the genito-urinary tract. A history of kidney stones or bladder stones increases the risk of acute bilateral obstructive uropathy.

Initially, the bladder reacts to the obstruction through 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 (see UTI - acute ). Urine may back up into the ureters and kidney. Symptoms develop because of urinary retention and/or damage to the bladder, ureters, and kidneys from backup (reflux) of urine.

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

Prevention:
This disorder may not be preventable in many cases. Routine rectal examination for men may reveal an enlarged prostate before it becomes large enough to obstruct the urethra.

Symptoms:

decreased urine output (may be less than 10 ml per day)
urinary hesitancy
abnormal urine flow--dribbling at the end of urination
incontinence
decrease in the force of the urinary stream, stream small and weak
urinary frequency/urgency, increased
need to urinate at night
frequent strong urge to urinate
burning or stinging with urination
feeling of incomplete emptying of the bladder
flank pain or pain in the sides
- on both sides
- began suddenly
blood in the urine
high blood pressure ( hypertension ), recent increase
urine, abnormal color

Signs and Tests:
Examination of the abdomen by touch ( palpation ) shows enlarged and tender kidneys. Palpation over the bladder shows bladder distention . Placement of a catheter in the bladder may relieve the lack of urine output. Post-void residuals (catheterized measurement of the volume of urine that remains in the bladder after urinating) are repeatedly more than 50 ml. Rectal examination usually shows an enlarged prostate. Blood pressure may be elevated. There may be signs and symptoms of acute renal failure . Fever with infection is common.

A urinalysis may be abnormal.
A clean catch urine specimen may show infection within the urinary tract.
The serum creatinine may increase suddenly, by 2 mg/dL or more over a two-week period.
The creatinine clearance may be decreased.
The BUN may increase suddenly.
A potassium test may be elevated.
Arterial blood gas and blood chemistries may show metabolic acidosis .

Hydronephrosis may be apparent in any of the following tests:

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

Treatment:
Treatment is focused on relieving the obstruction, which will allow urine to drain from the urinary tract. This allows the body to begin the natural healing process.

Catheterization may provide short-term relief of symptoms. This may be a catheter that is left in place (indwelling) or may involve intermittent catheterization.

Long-term relief is accomplished through correction of the cause of the obstruction.

Surgical reduction of the prostate, such as by a TURP ( transurethral resection of the prostate ) surgery corrects an enlarged prostate. Surgical intervention may also be appropriate for other disorders causing blockage of the urethra or bladder neck.

Prognosis:
Symptoms usually subside within a few weeks to several months if the cause is treated. Untreated, the disorder causes progressive damage to the kidneys and may cause kidney failure .

Complications:

Call Your Healthcare Provider:
Call your health care provider if decreased urine output , difficulty urinating , flank pain , or other symptoms of acute bilateral obstructive uropathy occur.

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.

This is an illustration of the female urinary tract. The female and male urinary tracts are relatively the same except for the length of the urethra. The positioning in the body and relative size of the organs are also demonstrated.

This is an illustration of the male urinary tract. The female and male urinary tract are relatively the same except for the length of the urethra. The positioning and relative size of the organs are also shown.