Obstructive uropathy

Last reviewed: 24 Apr 2022
Last updated: 09 Feb 2021

Summary

Definition

History and exam

Key diagnostic factors

  • signs of early organ dysfunction (tachypnea, tachycardia, hypotension, altered mental state) in a patient with suspected sepsis
  • flank pain
  • fever
  • 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)
More key diagnostic factors

Other diagnostic factors

  • haematuria
  • 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
Other diagnostic factors

Risk factors

  • benign prostatic hyperplasia (BPH)
  • constipation
  • medication (anticholinergic agents, narcotic analgesia, alpha receptor agonists)
  • urolithiasis (ureteric calculi)
  • spinal cord injury, Parkinson's disease, or multiple sclerosis
  • malignancy
  • pregnancy
  • haematuria
  • posterior urethral valves
  • bladder hernia
  • cystocele
  • iatrogenic injury
  • urethral instrumentation
  • retroperitoneal fibrosis
  • meatal stenosis
More risk factors

Diagnostic investigations

1st investigations to order

  • urinary dipstick
  • renal ultrasound
  • urea and creatinine
  • FBC
  • CT pyelogram
  • intravenous pyelogram (excretory urography)
More 1st investigations to order

Investigations to consider

  • 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)
More investigations to consider

Treatment algorithm

INITIAL

unilateral or bilateral obstruction with signs of infection

ACUTE

unilateral or bilateral obstruction due to calculi without signs of infection

unilateral obstruction not due to calculi without signs of infection

bilateral obstruction not due to calculi without signs of infection

Contributors

Authors

Adrienne J. Carmack, MD

Urologist

Integrative Health Matters

Tyler

TX

Disclosures

AJC declares that she has no competing interests.

Peer reviewers

Brian Cohen, MD

Private Practice Urologist

Asheville

NC

Disclosures

BC declares that he has no competing interests.

Yekutiel Sandman, MD

Private Practice Urologist

Miami

FL

Disclosures

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

Addenbrooke's Hospital

Cambridge

UK

Disclosures

VG declares that he has no competing interests.

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