Obstructive uropathy is blockage of urinary flow, which can occur at any level in the urinary tract. It may affect one or both kidneys, depending on the level of obstruction.
A number of underlying conditions can result in obstructive uropathy, most commonly urolithiasis and benign prostatic hyperplasia.
Initial treatment is directed at relieving pressure on the kidneys to prevent obstructive nephropathy and irreversible renal damage. Prompt relief of obstruction usually leads to preservation of kidney function. This may involve a urethral catheter, ureteric stent, or nephrostomy tube, depending on the level and cause of obstruction.
Subsequent treatment is targeted towards the underlying cause.
Infection within an obstructed system must be treated promptly.
Obstructive uropathy is blockage of urinary flow, which can affect one or both kidneys depending on the level of obstruction. If only one kidney is affected, urinary output may be unchanged and serum creatinine can be normal. When kidney function is affected, this is termed obstructive nephropathy. Hydronephrosis refers to dilation of the renal pelvis and can be present with or without obstruction. A variety of conditions may cause obstructive uropathy.
History and exam
- signs of early organ dysfunction (tachypnea, tachycardia, hypotension, altered mental state) in a patient with suspected sepsis
- flank pain
- lower urinary tract symptoms
- distended abdomen/palpable bladder
- inability to urinate
- enlarged or hard nodular prostate on rectal examination
- costovertebral angle tenderness
- neurological disease (e.g., spinal cord injury, multiple sclerosis)
- increasing age
- meatal narrowing
- pelvic or abdominal malignancy
- previous urethral instrumentation
- urinary tract infection in a child
- pelvic mass on internal examination
- weight loss and lymphadenopathy
- recurrent urinary tract infections
- urinary incontinence
- benign prostatic hyperplasia (BPH)
- medication (anticholinergic agents, narcotic analgesia, alpha receptor agonists)
- urolithiasis (ureteric calculi)
- spinal cord injury, Parkinson's disease, or multiple sclerosis
- posterior urethral valves
- bladder hernia
- iatrogenic injury
- urethral instrumentation
- retroperitoneal fibrosis
- meatal stenosis
- urine culture
- blood culture
- CT scan abdomen and pelvis
- magnetic resonance urography
- nuclear renography (triple renal/MAG3 scan)
- voiding cystourethrogram
- bladder ultrasound
- prostate specific antigen
- tumour markers (e.g., serum serum carcinoembryonic antigen [CEA], CA125)
Adrienne J. Carmack, MD
Integrative Health Matters
AJC declares that she has no competing interests.
Brian Cohen, MD
Private Practice Urologist
BC declares that he has no competing interests.
Yekutiel Sandman, MD
Private Practice Urologist
YS declares that he has no competing interests.
Vincent Gnanapragasam, MBBS, BMedSci, PhD, FRCSEng, FRCSEd(Urol)
Lecturer in Uro-oncology and Consultant Urological Surgeon
Department of Urology
VG declares that he has no competing interests.
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