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Obstructive uropathy

Uropathy - obstructive

 

Obstructive uropathy is a condition in which the flow of urine is blocked. This causes the urine to back up back up and injure one or both kidneys.

Causes

 

Obstructive uropathy occurs when urine cannot drain through a ureter (a tube that carries urine from the kidneys to the bladder). Urine backs up into the kidney and causes it to become swollen (hydronephrosis).

Obstructive uropathy can affect one or both kidneys. It can occur suddenly, or be a long-term problem.

Common causes of obstructive uropathy include:

  • Bladder stones
  • Kidney stones
  • Benign prostatic hyperplasia (enlarged prostate)
  • Bladder or ureteral cancer
  • Colon cancer
  • Cervical cancer
  • Uterine cancer
  • Any cancer that spreads
  • Scar tissue that occurs inside or outside of the ureters
  • Problems with the nerves that supply the bladder

Rarely, the problem occurs during pregnancy. This condition is called idiopathic hydronephrosis of pregnancy.

 

Symptoms

 

Symptoms depend on whether the problem starts slowly or suddenly, and if one or both kidneys are involved. Symptoms may include:

  • Mild to severe pain in the side of the body and the back (flank pain). The pain may be felt on one or both sides.
  • Fever
  • Nausea or vomiting
  • Weight gain or swelling (edema)

You may also have problems passing urine, such as:

  • Urge to urinate often
  • Decrease in the force of urine stream
  • Dribbling of urine
  • Not feeling as if the bladder is emptied
  • Need to urinate more often at night
  • Decreased amount of urine
  • Blood in urine

 

Exams and Tests

 

Imaging studies are done to diagnose obstructive uropathy. Commonly used tests include:

  • Ultrasound of the belly area (abdomen) or pelvis
  • CT scan of the belly area (abdomen) or pelvis
  • Intravenous pyelogram (IVP)
  • Voiding cystourethrogram
  • Renal nuclear scan
  • MRI

 

Treatment

 

Stents or drains placed in the ureter or in a part of the kidney called the renal pelvis may provide short-term relief of symptoms.

Nephrostomy tubes, which drain urine from the kidneys through the back, may be used to bypass the blockage.

A Foley catheter, placed through the urethra into the bladder, may also be help urine flow.

Short-term relief from the blockage is possible without surgery. However, the cause of the blockage must be removed and the urinary system repaired. Surgery may be needed for long-term relief from the problem.

The kidney may need to be removed if the blockage causes severe loss of function.

 

Outlook (Prognosis)

 

If the blockage comes on suddenly, kidney damage is less likely if the problem is detected and repaired right away. Often, the damage to the kidneys goes away. Long-term damage to the kidneys may occur if the blockage has been present for a long time.

If only one kidney is damaged, chronic kidney problems are less likely.

You may need dialysis or a kidney transplant if there is damage to both kidneys and they do not function, even after the blockage is repaired.

 

Possible Complications

 

Obstructive uropathy can cause permanent and severe damage to the kidneys, resulting in kidney failure.

If the problem was caused by a blockage in the bladder, the bladder may have long-term damage. This may lead to problems emptying the bladder or leakage of urine.

Obstructive uropathy is associated with a higher likelihood of urinary tract infections.

 

When to Contact a Medical Professional

 

Call your health care provider if you have symptoms of obstructive uropathy or suspect you may have this condition.

 

Prevention

 

Obstructive uropathy can be prevented by treating disorders that can cause it.

 

 

References

Meldrum KK. Pathophysiology of urinary tract obstruction. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 48.

Zeidel ML. Obstructive uropathy. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 123.

 
  • Bladder catheterization, female

    Bladder catheterization, female - illustration

    A catheter (a hollow tube, often with an inflatable balloon tip) may be inserted into the urinary bladder when there is a urinary obstruction, following surgical procedures to the urethra, in unconscious patients (due to surgical anesthesia, coma, or other reasons), or for any other problem in which the bladder needs to be kept empty (decompressed) and urinary flow assured. The balloon holds the catheter in place for a duration of time.

    Bladder catheterization, female

    illustration

  • Bladder catheterization, male

    Bladder catheterization, male - illustration

    Catheterization is accomplished by inserting a catheter (a hollow tube, often with and inflatable balloon tip) into the urinary bladder. This procedure is performed for urinary obstruction, following surgical procedures to the urethra, in unconscious patients (due to surgical anesthesia, coma, or other reasons), or for any other problem in which the bladder needs to be kept empty (decompressed) and urinary flow assured. The balloon holds the catheter in place for a duration of time. Catheterization in males is slightly more difficult and uncomfortable than in females because of the longer urethra.

    Bladder catheterization, male

    illustration

  • Female urinary tract

    Female urinary tract - illustration

    The female and male urinary tracts are relatively the same except for the length of the urethra.

    Female urinary tract

    illustration

  • Male urinary tract

    Male urinary tract - illustration

    The male and female urinary tracts are relatively the same except for the length of the urethra.

    Male urinary tract

    illustration

    • Bladder catheterization, female

      Bladder catheterization, female - illustration

      A catheter (a hollow tube, often with an inflatable balloon tip) may be inserted into the urinary bladder when there is a urinary obstruction, following surgical procedures to the urethra, in unconscious patients (due to surgical anesthesia, coma, or other reasons), or for any other problem in which the bladder needs to be kept empty (decompressed) and urinary flow assured. The balloon holds the catheter in place for a duration of time.

      Bladder catheterization, female

      illustration

    • Bladder catheterization, male

      Bladder catheterization, male - illustration

      Catheterization is accomplished by inserting a catheter (a hollow tube, often with and inflatable balloon tip) into the urinary bladder. This procedure is performed for urinary obstruction, following surgical procedures to the urethra, in unconscious patients (due to surgical anesthesia, coma, or other reasons), or for any other problem in which the bladder needs to be kept empty (decompressed) and urinary flow assured. The balloon holds the catheter in place for a duration of time. Catheterization in males is slightly more difficult and uncomfortable than in females because of the longer urethra.

      Bladder catheterization, male

      illustration

    • Female urinary tract

      Female urinary tract - illustration

      The female and male urinary tracts are relatively the same except for the length of the urethra.

      Female urinary tract

      illustration

    • Male urinary tract

      Male urinary tract - illustration

      The male and female urinary tracts are relatively the same except for the length of the urethra.

      Male urinary tract

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Obstructive uropathy

           

             

            Review Date: 3/28/2016

            Reviewed By: Scott Miller, MD, urologist in private practice in Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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