Acute bilateral obstructive uropathy

Definition

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

Alternative Names

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

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.

Support Groups

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.

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References

Pais VM Jr, Strandhoy JW, Assimos DG. Pathophysiology of urinary tract obstruction. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 37.

Hsu THS, Streem SB, Nakada SY. Management of upper urinary tract obstruction. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 38.

McAninch JW, Santucci RA. Renal and ureteral trauma. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 39.

Frøkiaer J, Zeidel ML. Urinary tract obstruction. In: Brenner BM, ed. Brenner and Rector's The Kidney. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 35.