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Acute bilateral obstructive uropathyDefinition Acute bilateral obstructive uropathy is a sudden blockage of the flow of urine from both kidneys. Causes, incidence, and risk factors Obstructive uropathy occurs when the flow of urine is blocked. The kidneys continue to produce urine in the normal manner, but the urine does not drain properly because of the obstruction. This causes swelling of the kidneys (hydronephrosis). A sudden blockage that affects both kidneys causes acute bilateral obstructive uropathy. The condition may eventually lead to hypertension or acute renal failure. In men, acute bilateral obstructive uropathy is most often a result of an enlarged prostate. Other causes in men include prostate cancer, bilateral obstructing kidney stones and bladder cancer. Acute bilateral obstructive uropathy is much less common in women, but may occur as a result of a bladder cystocele, pregnancy, injury from surgery involving the reproductive organs, or cervical cancer. Other causes include posterior urethral valves in infant boys, neurogenic bladder, papillary necrosis, coagulated blood, fungus and other rare retroperitoneal processes. Acute bilateral obstructive uropathy occurs in about 5 out of 10,000 people. Symptoms
Signs and tests A physical exam may show swollen or tender kidneys. The bladder may be large and full. A rectal examination may reveal an enlarged prostate. Signs and symptoms of chronic renal failure may be present. Blood pressure may be high. Fever is common with an infection.
The following tests may show hydronephrosis (swelling of kidneys): 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. The patient may need to stay in a hospital for a short while. A tube placed into the body to relieve urine (cathertization) may provide short-term relief of symptoms. Techniques may use a urethral (Foley) catheter, intermittent self-catheterization, or a suprapubic tube (tube directly draining the bladder through the abdominal wall). Antibiotics or other medications may be given. Long-term relief is accomplished through correction of the cause of the obstruction. Surgery such as TURP (transurethral resection of the prostate) or newer techniques that use laser or heat therapy to shrink the prostate may be helpful if the cause of the problem is an enlarged prostate. Surgery may also be needed for other disorders that cause blockage of the urethra or bladder neck. Expectations (prognosis) If the acute obstruction is quickly relieved, symptoms usually subside within hours to days . If untreated, the disorder causes progressive damage to the kidneys, and may cause kidney failure and death. Complications
Calling your health care provider Call your health care provider if decreased urine output, difficulty urinating, flank pain, or other symptoms of acute bilateral obstructive uropathy occur. Prevention This disorder may not be preventable in many cases. Routine annual physicals with a primary care physician are recommended. Iffound to have acute obstructive uropathy, the patient should go to the nearest emergency room and consult a urologist. References Walsh PC. Campbell's Urology. 8th ed. St. Louis, Mo: WB Saunders; 2002:412. Goldman L, Ausiello D. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa: WB Saunders; 2004:741-742. Illustrations
Page Content: Urethral obstruction; Acute urethral obstruction; Obstructive uropathy - bilateral - acute |
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