Summary
Definition
History and exam
Key diagnostic factors
- sinais de disfunção orgânica precoce (taquipneia, taquicardia, hipotensão, estado mental alterado) em um paciente com suspeita de sepse
- dor no flanco
- febre
- sintomas do trato urinário inferior
- abdome distendido/bexiga palpável
- incapacidade de urinar
- próstata aumentada ou nodular com consistência dura no exame retal
- sensibilidade no ângulo costovertebral
- doença neurológica (por exemplo, lesão da medula espinhal, esclerose múltipla)
Other diagnostic factors
- hematúria
- idade mais avançada
- estreitamento meatal
- malignidade abdominal ou pélvica
- intervenção uretral prévia
- infecção do trato urinário em uma criança
- massa pélvica no exame físico interno
- perda de peso e linfadenopatia
- infecção do trato urinário recorrente
- incontinência urinária
Risk factors
- hiperplasia prostática benigna (HPB)
- constipação
- medicamentos (agentes anticolinérgicos, analgésicos opioides, agonistas do receptor alfa)
- urolitíase (cálculos ureterais)
- lesão da medula espinhal, doença de Parkinson ou esclerose múltipla
- neoplasia maligna
- gestação
- hematúria
- valvas uretrais posteriores
- hérnia vesical
- cistocele
- lesão iatrogênica
- intervenção uretral
- fibrose retroperitoneal
- estenose meatal
Diagnostic tests
1st tests to order
- tira reagente para exame de urina
- ultrassonografia renal
- ureia e creatinina
- Hemograma completo
- TC de abdome e pelve sem contraste
Tests to consider
- urocultura
- hemocultura
- TC de abdome e pelve, com e sem contraste
- urografia por ressonância magnética (URM)
- pielograma intravenoso (urografia excretora)
- renografia nuclear (cintilografia renal tripla/MAG3)
- cistouretrografia miccional
- ultrassonografia da bexiga
- antígeno prostático específico
- marcadores tumorais (por exemplo, antígeno carcinoembriogênico [CEA] sérico, CA125)
Treatment algorithm
obstrução unilateral ou bilateral com sinais de infecção
obstrução uni ou bilateral decorrente de cálculos sem sinais de infecção
obstrução unilateral não decorrente de cálculos, sem sinais de infecção
obstrução bilateral não decorrente de cálculos, sem sinais de infecção
Contributors
Authors
Harris E. Foster Jr., MD
Professor of Urology
Section Chief of Lower Urinary Tract Dysfunction and Reconstruction
Yale School of Medicine
New Haven
CT
Disclosures
HEF declares that he has no competing interests.
Adam Benjamin Hittelman, MD, PhD
Associate Professor in Urology
Section Chief of Pediatric Urology
Yale School of Medicine
New Haven
CT
Disclosures
ABH declares that he has provided expert testimony and has given lectures on obstructive uropathy.
Parth M. Patel, MD
Assistant Professor of Urology
Department of Urology
University of California Los Angeles
Los Angeles
CA
Disclosures
PMP declares that he has no competing interests.
Acknowledgements
Harris E. Foster Jr., Adam Benjamin Hittelman, and Parth M. Patel would like to gratefully acknowledge Adrienne J. Carmack, a previous contributor to this topic.
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Wessells H, Morey A, Souter L, et al. Urethral stricture disease guideline amendment (2023). J Urol. 2023 Jul;210(1):64-71.Full text Abstract
American College of Radiology. ACR appropriateness criteria: acute onset flank pain-suspicion of stone disease (urolithiasis). 2023 [internet publication].Full text
American Urological Association; Endourological Society. Surgical management of stones: AUA/Endourology Society guideline. 2016 [internet publication].Full text
Sandhu JS, Bixler BR, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA guideline amendment 2023. J Urol. 2024 Jan;211(1):11-19.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Cisto parapélvico
- Hidronefrose da gestação
- Aneurisma da aorta abdominal
More DifferentialsGuidelines
- EAU guidelines on urolithiasis
- EAU guidelines on urolithiasis
More GuidelinesPatient information
Cateterização (homens): ter um cateter instalado
Cateterismo (feminino): colocação de um cateter
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer