Cbstruct|ve uropathy

CbsLrucLlve uropaLhy ls a condlLlon ln whlch Lhe flow of urlne ls blocked causlng lL Lo back up and ln[ure
one or boLh kldneys
Obstructive uropathy is grouped according to whether it aIIects one or both kidneys and whether
it occurs suddenly or is long-term:
O Chronic unilateral obstructive uropathy - Long-term uropathy that aIIects one kidney
O Chronic bilateral obstructive uropathy - Long-term uropathy that aIIects both kidneys
O Acute unilateral obstructive uropathy - Sudden uropathy that aIIects one kidney
O Acute bilateral obstructive uropathy - Sudden uropathy that aIIects both kidneys
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Some causes oI obstructive uropathy include the Iollowing:
O Benign prostatic hyperplasia (enlarged prostate)
O Urethral stricture
O Prostate cancer
O Bladder or ureteral cancer
O Colon cancer
O Cervical cancer
O Uterine cancer
O Any cancer that spreads
O Idiopathic hydronephrosis oI pregnancy
O Urinary tract stones
4 Ureteral stones
4 Bladder stones
O Urinary tract tumors
O Retroperitoneal Iibrosis
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Symptoms 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 oI obstructive uropathy include the Iollowing:
O Flank pain
4 Bilateral or unilateral
4 Colicky or severe
O Urinary tract inIection
O Fever
O DiIIiculty or pain while urinating
O Nausea or vomiting
O Renal Iailure
O Weight gain or swelling (edema)
O Blood in the urine
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The diagnosis oI obstructive uropathy is made on imaging studies. Common radiographic studies
used to diagnose obstructive uropathy include:
O Abdominal ultrasound
O Abdominal CT scan
O Intravenous pyelogram (IVP)
O Voiding cystourethrogram
O Renal nuclear scan
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Stents or drains placed in the ureter or in the renal pelvis may provide short-term relieI oI
symptoms. Nephrostomy tubes, which drain urine Irom the kidneys through the back, may be
used to bypass the obstruction. A Foley catheter, inserted through the urethra, may also be
helpIul.
Although temporary relieI Irom the obstruction can be achieved without surgery, the cause oI the
obstruction must be removed and the urinary system repaired. Long-term relieI Irom obstructive
uropathy requires surgery.
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II an acute obstruction is rapidly diagnosed and repaired, kidney damage is minimal or reversible
-- regardless oI being unilateral or bilateral.
II chronic unilateral obstruction is not relieved promptly, there could be permanent damage to
the kidney. Chronic unilateral obstruction usually does not cause kidney insuIIiciency or Iailure
because most patients have normal Iunction Irom the other kidney.
Chronic bilateral obstruction may lead to kidney insuIIiciency or Iailure because both kidneys
may become damaged and Iail to Iunction even aIter the obstruction is repaired.
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Obstructive uropathy can cause permanent and severe damage to the kidneys, resulting in renal
Iailure. 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.



ReIerences;
Pais VM Jr, Strandhoy JW, Assimos DG. Pathophysiology oI 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 oI 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 Rectors The
Kidney. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 35.