What is Obstructive Uropathy?
Obstructive uropathy is a condition where there’s a blockage that prevents urine from flowing properly in your urinary tract. This blockage could be due to physical structure issues or functional problems in the urinary system. When this happens, urine can back up into one or both kidneys – a situation known as hydronephrosis.
Depending on where the blockage is located, you might experience a variety of symptoms like difficulty starting to urinate, not being able to urinate at all (acute urinary retention), or feeling discomfort and swelling in the lower abdomen. The problem can suddenly happen or build up over time. Anyone, regardless of their age or demographic, can develop this condition. This is a simple review of what obstructive uropathy is.
What Causes Obstructive Uropathy?
Obstructive uropathy, a condition where the flow of urine is blocked, can have many potential causes. The most common cause is an enlarged prostate, also known as benign prostatic hypertrophy or hyperplasia. However, it can also be caused by less common factors such as constipation, strictures (narrowing) of the urethra, phimosis or paraphimosis (tightness of the foreskin), prostate cancer, lymph node enlargement in the abdomen, endometriosis in the colon, ureterocele (a pouch in the ureter), kidney stones, bladder problems due to nerve issues, parasites blocking the urinary tract, bladder endometriosis, and urate kidney stones.
To figure out the cause, it’s important to do a thorough check-up, including a medical history and a physical examination. Obstructive uropathy can also occur in newborn babies, which is why it’s important to check the urinary tract and test for urine backing up into the kidneys during the neonatal period. This also emphasizes the importance of having ultrasounds done during pregnancy to check the baby’s anatomy.
Risk Factors and Frequency for Obstructive Uropathy
Urinary obstruction is a condition that can occur at any age, but it is most often seen in infants and elderly individuals. In children, urinary obstruction might be due to inherited problems with the urinary tract, which accounts for about 4% of the total cases. In contrast, people over the age of 60, particularly males, make up the largest group affected by this issue due to prostate-related problems such as benign prostatic hyperplasia (BPH) and cancers. It is estimated that 1 to 2% of men with BPH experience symptoms of urinary obstruction every year. However, this problem is much less common in women.
- Urinary obstruction is a condition that affects all ages, but is most common in infants and people over 60.
- 4% of total cases are due to urinary tract problems that are present from birth, particularly in children.
- People over 60—most often men—are the largest group affected by this condition mainly due to prostate-related issues.
- Each year, 1 to 2% of men with benign prostatic hyperplasia (BPH) experience symptoms of urinary obstruction.
- Urinary obstruction is significantly less common in women.
Signs and Symptoms of Obstructive Uropathy
Urinary tract obstructions can cause varying symptoms, depending on how severe the obstruction is, where it is located, and how long it’s been since it started. The common sign of this condition is pain. Patients often feel discomfort in their stomach area or along their sides. The type, location, and intensity of the pain, as well as what makes it better or worse, can help pinpoint the root cause. For example, a dull pain in the side that suddenly becomes sharp around the lower abdomen or groin could hint at a kidney stone causing the obstruction.
Frequent urination at night, pain or burning during urination, urgency to urinate, and a weak urinary stream might indicate an enlarged prostate or prostate cancer. Having a fever could mean a urinary tract infection is present and could potentially lead to sepsis. If someone has recently lost weight without trying, has night sweats, notices blood in their urine, and their prostate feels lumpy during a checkup, prostate cancer could be a possibility.
Prior treatments for cancer can result in scarring within the urinary tract, causing a blockage. Symptoms such as constipation, nausea, vomiting, and diarrhea could be signs of a bowel blockage, a large mass in the colon, or severe constipation, which are all potential causes for urinary blockage. Recent surgeries like the removal of the appendix or the uterus may lead to damage to the tubes that carry urine from the kidneys to the bladder, resulting in an obstruction.
During a physical exam, clinicians will look out for a swollen bladder as it could indicate that urine is backing up. A rectal exam may uncover enlarged prostate or hard, packed stool. Testing strength, sensations, reflexes, and muscle tone could provide more clues. A thorough evaluation of the patient’s history and symptoms is often enough to identify the cause of the obstruction.
- Abdominal or flank pain
- Urination at night
- Pain or burning during urination
- Urinary urgency
- Decreased force during urination
- Fever
- Unintentional weight loss
- Night sweats
- Blood in urine
- Constipation, nausea, vomiting, or diarrhea
Testing for Obstructive Uropathy
If your doctor suspects that you have obstructive uropathy, which is a condition where normal urine flow is blocked, they may carry out several tests to confirm the diagnosis and check how well your kidneys are functioning. Obstructive uropathy can lead to serious kidney damage if not treated promptly.
One of these tests is known as a basic metabolic panel. This is a blood test that looks at different chemicals in your blood and helps to assess your general health, as well as kidney function. Aside from this, your doctor may ask you to provide a urine sample for a urinalysis test to check for urinary tract infection that could be causing the blockage.
Two other tests, which measure the ratio of protein to creatinine and electrolyte levels in your urine, may also be carried out. They can provide additional information to guide your treatment moving forward.
One of the first tests usually done when obstructive uropathy is suspected is ultrasound, which uses sound waves to create pictures of the inside of your body. This test is typically done at the bedside and is used to measure the amount of urine in your bladder and check for hydronephrosis, a condition that occurs when there is a swelling of the kidneys due to urine failing to properly drain from the kidney to the bladder.
In case the ultrasound doesn’t provide enough information or if there is concern about other problems in your abdomen like tumors, a CT (computed tomography) scan of your abdomen and pelvis may also be carried out. A CT scan uses X-rays to make detailed pictures inside your body.
Additional tests such as intravenous pyelogram, voiding cystourethrogram, and renal nuclear scans might be carried out depending on your specific situation. An intravenous pyelogram is a type of X-ray of your kidneys, bladder, and ureters. A voiding cystourethrogram uses X-rays to assess the functioning of the bladder and check for any issues. In renal nuclear scans, a small amount of radioactive substance is used to evaluate the kidneys and their function. In some cases, MRI (magnetic resonance imaging), which uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body, might also be considered.
Treatment Options for Obstructive Uropathy
If your kidney function is not on par or you show signs of an electrolyte imbalance, it might be necessary for you to get hospitalized and discussed with kidney disease specialists (or nephrologists). The doctors might test your urine to check for infections, and if required, prescribe antibiotics. They would usually collect a sample of your urine for lab testing.
Obstructive uropathy, a condition where the flow of urine is blocked, is typically treated by addressing the cause of the blockage. How much urine the bladder can hold, can guide the doctor on the next steps of treatment. They might try to insert a tube called a Foley catheter, especially if the blockage is because of a common cause such as an enlarged prostate condition known as benign prostatic hypertrophy.
Sometimes a blockage might prevent successful catheter insertion, in which case, advanced procedures would be necessary. For very difficult cases, an alternative approach might involve inserting the catheter directly into the bladder from the abdominal area. The duration of keeping the Foley catheter depends on multiple factors, including the calculated initial and post-procedure amount of urine in the bladder.
A urologist (a kidney and urinary system specialist) should monitor your progress, as they will play a crucial role in deciding any further treatment and when to remove the Foley catheter. Sometimes, it’s possible that you might need the catheter again. If that happens, other interventions like using a tube to facilitate urine flow from the kidney, could be considered.
There might be cases where medications can help. Medicines like tamsulosin and terazosin help to relax the muscles in the bladder neck and prostate, which can alleviate the symptoms caused by an enlarged prostate. There’s evidence that tamsulosin is effective for moderate to severe obstructive symptoms. Although people often worry about low blood pressure when using these types of drugs, many studies suggest there are no significant side effects.
Drugs such as bicalutamide and leuprolide can help minimize blockages due to an enlarged prostate, by causing the prostate to shrink.
Finasteride and dutasteride, approved by the FDA for treating the conditions resulting from an enlarged prostate, work by blocking the action of a particular enzyme in your body that converts testosterone, a hormone, to another variant of it, helping reduce the size of the prostate.
Relieving the obstruction in the urinary tract is also the first step in managing kidney damage due to blockage, albeit this topic is complex and won’t be covered in depth in this summary.
What else can Obstructive Uropathy be?
The difficulty in diagnosing a patient based on their symptoms, particularly when they involve urinary retention, can be influenced significantly by many factors. These include the location and timing of the symptoms, as well as the individual’s health risks. By carefully examining a patient and taking a detailed account of their medical history, doctors can rule in or rule out potential diagnoses. For example, a person having difficulty passing urine could be dealing with a range of issues such as:
- Blockage in their urinary tract
- Infection
- Side effect of a medication
- Spinal cord pressure
- Dysfunction of the detrusor muscle (the muscle that lets urine out of the bladder)
That same symptom can also be a sign of an acute or chronic medical condition. Other symptoms, like fever, could suggest an infection like a kidney infection or a spinal abscess. If the person also experiences one-sided lower back pain and has a history of kidney stones, that could indicate a kidney stone blocking the ureter.
Surgeons also consider the patient’s medical procedures history. If they’ve had a urologic procedure before, there could be a narrowing in the urethra or blood clots causing a blockage. Any neurological symptoms could suggest the person had a stroke or a spinal cord disease.
Furthermore, a history of injecting drugs could point to a spinal abscess or inflammation of the spinal discs. If the person has cancer, there may be a concern for spinal cord or vertebral metastases. Aortic aneurysm or dissection could be a cause for lower back pain if the person has a history of high blood pressure and smoking. Constipation or fecal impaction could also cause a urinary tract obstruction. Finally, changes in medication or recent anesthesia use could lead to difficulties with urination. But as always, the medical history and a physical examination will help guide the next steps in diagnosis and treatment.
What to expect with Obstructive Uropathy
The outlook of a urologic obstruction, or a blockage in the urinary system, largely depends on what caused it in the first place. Obstructions that occur suddenly (acute) are more often than not, reversible and less likely to cause damage to our kidneys’ filtering system. However, obstructions that have been present for a long time (chronic) can have more serious effects on kidney health over time.
If only one kidney is affected by the blockage initially, it’s less likely that chronic kidney-related complications will develop. After an acute obstruction has been resolved, it’s uncommon, but not impossible, for kidney dysfunction to persist or worsen. In such cases, the person may need to have long-term treatments like dialysis (a procedure to remove waste and excess water from the blood) or even a kidney transplant.
The outlook can worsen if the person also has urinary tract infections (UTIs) that aren’t treated. UTIs are infections that happen in any part of the urinary system, which includes the kidneys, bladder, ureters, and urethra.
Possible Complications When Diagnosed with Obstructive Uropathy
: Complications can arise depending on the specific cause of a medical problem and treatment varies on a case-by-case basis. In particular, a kidney obstruction can cause permanent damage and even failure of the kidneys if not dealt with in time. Although this is less likely to happen during an acute (sudden) obstruction, the likelihood increases if the obstruction is chronic (long-term).
It’s really important to watch for signs of obstruction in newborn babies, as kidney obstruction can lead to kidney failure. If this happens, it can cause serious long-term health problems and can even be life-threatening. It’s worth noting that kidney obstructions have been responsible for about 16.5% of all kidney transplants in children.
Identifying kidney problems before birth can improve the child’s overall health. This highlights the importance of routine ultrasound scans during pregnancy. Kidney obstructions could also increase the chance of urinary tract infections. In some cases, the infection could be the first sign of an obstruction.
It’s common to see minor blood in urine after having a catheter put in, but more serious bleeding needs medical attention. This may require a continuous bladder irrigation procedure using a special type of catheter called a 3-way Foley. After the Foley is placed, the patient may experience temporary low blood pressure and slow heart rate, but these usually go away on their own.
In the past, it was believed that the bladder should be emptied gradually to prevent low blood pressure. However, recent studies have found no significant difference in results between draining the bladder slowly or quickly. There’s also a risk for excessive urine production after the obstruction is cleared. These patients might need to stay in the hospital for close monitoring of their vital signs and electrolyte levels.
Reactions and Possible Complications:
- Kidney damage or failure
- Serious long-term health impacts and potential life-threat in newborns
- Urinary tract infections
- Blood in urine requiring medical attention
- Temporary low blood pressure and slow heart rate
- Excessive urine production
Preventing Obstructive Uropathy
If you have obstructive uropathy, it’s crucial that you know how to take care of your catheter. This involves knowing how to correctly attach it and keeping an eye on how much urine you’re producing. It’s also important to recognize when you need immediate medical attention. Signs you should look out for include a fever, if your Foley catheter becomes blocked, if you notice a large amount of blood in your urine, or if you experience severe pain.
You should also follow your recommended treatment plan closely to manage any underlying conditions and to help prevent the issue from occurring again. If you’ve been prescribed any medication, it’s important that you’re aware of any potential side effects.
