Acute bilateral obstructive uropathy

Acute bilateral obstructive uropathy

Urethral obstruction- Acute urethral obstruction- Obstructive uropathy - bilateral - acute

Acute bilateral obstructive uropathy is a sudden blockage of the flow of urine from both kidneys. The kidneys continue to produce urine in the normal manner, but because urine does not drain properly, the kidneys start to swell.

See also:

Chronic unilateral obstructive uropathy

Chronic bilateral obstructive uropathy

Acute unilateral obstructive uropathy

Causes, incidence, and risk factors

In men, acute bilateral obstructive uropathy is most often a result of an enlarged prostate. Other causes in men include:

Bladder cancer

Kidney stones

Prostate cancer

Acute bilateral obstructive uropathy is much less common in women, but may be due to:

Bladder cystocele

Cervical cancer

Injury from surgery involving the reproductive organs

Pregnancy

Other causes in men and women include:

Blood clots

Neurogenic bladder

Other rare retroperitoneal processes

Papillary necrosis

Posterior urethral valves in infant boys

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

Symptoms

Abnormal urine flow -- dribbling at the end of urination

Blood in the urine

Burning or stinging with urination

Decrease in the force of the urinary stream, stream small and weak

Decreased urine output (may be less than 10 mL per day)

Feeling of incomplete emptying of the bladder

Fever

Frequent strong urge to urinate

Recent increase in blood pressure

Leakage of urine (incontinence)

Nausea and vomiting

Need to urinate at night

Sudden flank pain or pain on both sides

Urinary hesitancy

Urine, abnormal color

Signs and tests

The doctor will perform a physical exam. The exam may show:

Large and full bladder

Swollen or tender kidneys

Enlarged prostate (men)

There may be signs of chronic kidney failure, high blood pressure, and infection. Fever is common with an infection.

Tests that may be done include:

Arterial blood gas and blood chemistries

Basic metabolic panel -- will reveal kidney function and electrolyte balance

Blood BUN

Creatinine clearance

Complete blood count

Potassium test

Serum creatinine test

Urinalysis and a urine culture (clean catch)

Ultrasound of the bladder

Uroflowmetry

The following tests may show hydronephrosis (swelling of kidneys):

IVP

Renal scan

Ultrasound of the kidneys

Abdominal CT scan

Treatment

The goal of treatment is to relieve the blockage, which will allow urine to drain from the urinary tract. You may need to stay in a hospital for a short while.

Short-term treatment may include:

Antibiotics and other medications to treat symptoms

Catheterization-- the placement of a tube into the body to drain urine (See: Urinary catheters)

Long-term treatment involves correcting the cause of the blockage. This may involve:

Surgery such as transurethral resection of the prostate (TURP)

Laser or heat therapy to shrink the prostate if the problem is due to 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 go away within hours to days. If untreated, the disorder causes progressive damage to the kidneys. It may eventually lead to high blood pressure or kidney failure.

Complications

Acute kidney failure

Chronic bilateral obstructive uropathy

High blood pressure

Reflux nephropathy

Urinary tract infection

Urinary retention or incontinence

Calling your health care provider

Call your health care provider if you have decreased urine output, difficulty urinating, flank pain, or other symptoms of acute bilateral obstructive uropathy.

Prevention

You may not be able to prevent this condition. Routine annual physicals with a primary care doctor are recommended. If your doctor finds you have acute obstructive uropathy, you should be referred to the nearest emergency room and seen by a urologist.