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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
Urethral obstruction; Acute urethral obstruction; Obstructive uropathy - bilateral - acute
Causes, incidence, and risk factorsIn 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
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):
TreatmentThe 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 pressureor kidney failure.
Complications- Acute kidney failure
- Chronic bilateral obstructive uropathy
- High blood pressure
- Reflux nephropathy
- urinary tract infection
- Urinary retention or incontinence
Call your health care provider if you have decreased urine output, difficulty urinating, flank pain, or other symptoms of acute bilateral obstructive uropathy.
PreventionYou 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.
ReferencesPais 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.
Frokiaer 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.
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Obstructive uropathy?
DefinitionObstructive uropathy is a condition in which the flow of urine is blocked, causing it to back up and injure one or both kidneys.Alternative NamesUropathy - obstructiveCauses, incidence, and risk factorsObstructive 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 is grouped according to whether it affects one or both kidneys and whether it occurs suddenly or is long-term:Chronic unilateral obstructive uropathy - Long-term uropathy that affects one kidneyChronic bilateral obstructive uropathy - Long-term uropathy that affects both kidneysAcute unilateral obstructive uropathy - Sudden uropathy that affects one kidneyAcute bilateral obstructive uropathy -Sudden uropathy that affects both kidneysCommon causes of obstructive uropathy include the following:Urinary tract stonesUreteral stonesBladder stonesUrinary tract tumorsRetroperitoneal fibrosisBenign prostatic hyperplasia (enlarged prostate)Tumors of nearby organsBladder or ureteral cancerColon cancerCervical cancerUterine cancerAny cancer that spreadsIdiopathic hydronephrosis of pregnancySymptomsSymptoms associated with obstructive uropathy vary depending on whether the obstruction is acute or chronic, whether it is unilateral or bilateral, whether it is complete or partial, and what caused it. Common symptoms of obstructive uropathy include the following:Flank painBilateral or unilateralColicky or severeUrinary tract infectionFeverDifficulty or pain while urinatingNausea or vomitingRenal failureWeight gain or swelling (edema)Decreased urine outputBlood in the urineSigns and testsThe diagnosis of obstructive uropathy is made on imaging studies. Common radiographic studies used to diagnose obstructive uropathy include:Abdominal ultrasoundAbdominal CT scanIntravenous pyelogram (IVP)Voiding cystourethrogramRenal nuclear scanTreatmentStents or drains placed in the ureter or in 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 obstruction. A Foley catheter, inserted through the urethra, may also be helpful.Although temporary relief from the obstruction can be achieved without surgery, the cause of the obstruction must be removed and the urinary system repaired. Long-term relief from obstructive uropathy requires surgery.Expectations (prognosis)If an acute obstruction is rapidly diagnosed and repaired, kidney damage is minimal or reversible -- regardless of being unilateral or bilateral.If chronic unilateral obstruction is not relieved promptly there could be permanent damage to the kidney. Chronic unilateral obstruction usually does not cause kidney insufficiency or failure because most patients have normal function from the other kidney.Chronic bilateral obstruction may lead to kidney insufficiency or failure because both kidneys may become damaged and fail to function even after the obstruction is repaired.For more specific information, see the individual articles below:Chronic unilateral obstructive uropathyChronic bilateral obstructive uropathyAcute unilateral obstructive uropathyAcute bilateral obstructive uropathyComplicationsObstructive uropathy can cause permanent and severe damage to the kidneys, resulting in renal failure. Obstructive uropathy caused by bladder outlet obstruction can lead to permanent and severe damage to the bladder, resulting in problems such as incontinence and urinary retention.Calling your health care providerContact your health care provider if you have symptoms of obstructive uropathy or believe that you may be suffering from this condition.PreventionObstructive uropathy can be prevented by addressing any underlying disorders that can cause it.ReferencesPais VM Jr, Strandhoy JW, Assimos DG. Pathophysiology of urinary tract obstruction. In: Wein AJ, ed. 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.Frokiaer 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.
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What shape has 2 equal sides 2 equal angles and no right angles?
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Acute unilateral obstructive uropathy?
DefinitionAcute unilateral is a sudden blockage in one of the tubes (ureters) that drain urine from the kidneys.See also:Acute bilateral obstructive uropathyChronic unilateral obstructive uropathyChronic bilateral obstructive uropathyObstructive uropathyAlternative NamesObstructive uropathy - unilateral - acute; Ureteral obstructionCauses, incidence, and risk factorsUnilateral obstructive uropathy is most often caused by a kidney stone, although injury or other conditions could cause the disorder.When urine flow is blocked, it backs up into the kidney. This leads to kidney swelling, also called hydronephrosis.You have a greater risk for unilateral obstructive uropathy if you have ureteral stones and tumors, kidney stones, and tumors in nearby body structures such as the uterus and cervix.Acute unilateral obstructive uropathy occurs in 1 in 1,000 people.SymptomsAbdominal pain,right or left lower quadrantAbnormal urine color (tan, cola colored, tea colored)Back pain, may be on only one sideBlood in the urineFeverFlank pain or pain in the sideSevere enough to require strong pain medicinePain on one side; it may move to the groin, genitals, and thighPain comes and goes; intensity changes over minutesFoul-smelling urineHigh blood pressure that has increased recently (within 2 weeks)Mental status changesNauseaUrinary frequencyUrinary urgencyUrinary tract infectionVomitingSigns and testsThe health care provider will perform a physical exam. Pressing with the fingers on (palpation of) the belly area may reveal a swollen or tender kidney. Blood pressure may be high.The following tests may be done:Basic metabolic panelComplete blood count (CBC)UrinalysisUrine cultureKidney swelling or blockage of the ureter may be seen on these tests:Abdominal CT scanAbdominal ultrasoundIntravenous pyelogram (IVP)Kidney scanTreatmentThe goal of treatment is to relieve or reduce the blockage.Antibiotics may be given if there is a urinary tract infection.Stents or drains placed in the ureter or nearby area may provide short-term relief of symptoms. Surgery to repair the underlying cause of the obstruction will usually cure the problem.Kidney surgery, including removal of the kidney (nephrectomy) may be needed if kidney function is poor or if there is a bad infection.Expectations (prognosis)The outcome varies. The disorder may result in permanent damage to the kidney. However, kidney failure usually does not result because the second kidney continues to function.ComplicationsChronic or recurrent urinary tract infectionChronic unilateral obstructive uropathyHypertensionPermanent failure of the affected kidney (chronic renal failure)Calling your health care providerCall your health care provider if you develop flank pain or other symptoms of acute unilateral obstructive.Call your health care provider if symptoms worsen during or after treatment, or if new symptoms develop.PreventionIf you are prone to kidney stones, drink plenty of water (6 to 8 glasses per day) to reduce the chance of their formation.Research suggests that a diet low in sodium and oxalate and high in citrate significantly reduces risk of calcium-based kidney stone formation. Consult with a nutritionist for more information on such diets.Seek medical attention if kidney stones persist or come back to identify the cause and to prevent new stones from forming.ReferencesPeters CA. Perinatal urology. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Sauders Elsevier; 2007: chap 109.Pais VM, Strandhoy JW, Assimos DG. Pathophysiology of urinary tract obstruction. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Sauders 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: Sauders Elsevier; 2007: chap 38.Frokiaer 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.
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Kathleen Sullivan Still has written: 'The motor and secretory activity of the stomach during acute and chronic obstructive jaundice in dogs' -- subject(s): Dogs, Gastric juice, Hunger, Obstructive Jaundice, Physiological aspects, Physiological aspects of Obstructive jaundice, Physiology, Stomach
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