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Acute bilateral obstructive uropathy
Alternative namesUrethral obstruction; Acute urethral obstruction; Obstructive uropathy - bilateral - acute
DefinitionAcute bilateral obstructive uropathy is a sudden blockage of the flow of urine from both kidneys, which can cause the backup of urine and kidney injury.
Causes, incidence, and risk factors
Obstructive uropathy occurs when the flow of urine is blocked. The kidneys produce urine in the normal manner but the urine does not drain properly because of the obstruction. Pressure in the urinary tract rises, resulting in hydronephrosis (swelling of the kidneys) and bilateral obstructive uropathy (damage to both kidneys caused by obstruction of urine). Obstructive uropathy may eventually lead to hypertension and/or acute renal failure . Sudden blockage causes acute bilateral obstructive uropathy, while slow, progressive blockage causes chronic bilateral obstructive uropathy .
Initially, the bladder reacts to the obstruction through increased irritability. There is a stronger and more frequent urge to urinate , and bladder spasms or incontinence may occur. As urine accumulates, it may lead to stasis of urine and urinary tract infections (see UTI - acute ). Urine may back up into the ureters (tubes which carry urine from the kidneys to the bladder) and kidney. Symptoms develop because of urinary retention and/or damage to the bladder, ureters and kidneys.
Signs and testsExamination by touch ( palpation ) shows enlarged and tender kidneys. Palpation over the bladder shows bladder distention . Placement of a catheter in the bladder may relieve the lack of urine output. Post-void residuals (catheterized measurement of the volume of urine that remains in the bladder after urinating) are repeatedly more than 50 mL. Rectal examination usually shows an enlarged prostate in men. Blood pressure may be elevated. There may be signs and symptoms of acute renal failure . Fever with infection is common.
Treatment is focused on relieving the obstruction, which will allow urine to drain from the urinary tract. This allows the body to begin the natural healing process.
Antibiotics or other medications may need to be given upon diagnosis of infection or renal failure. Initial evaluation and treatment may require hospitalization.
Long-term relief is accomplished through correction of the cause of the obstruction.
Symptoms usually subside within hours to days if the acute obstruction is immediately relieved. If untreated, the disorder causes progressive damage to the kidneys and may cause kidney failure and death.
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.
This disorder may not be preventable in many cases. Routine annual physicals with a primary care physician are recommended. If the patient is found to have acute obstructive uropathy, he or she should go to the nearest emergency room and urological consultation is required.
Update Date: 5/25/2002Young Kang, M.D., Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT