Health Encyclopedia

Acute bilateral obstructive uropathy

Definition

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.

Alternative Names

Urethral obstruction; Acute urethral obstruction; Obstructive uropathy - bilateral - acute

Causes, incidence, and risk factors

In 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

Signs and tests

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):

This disease may also alter the results of the following tests:

Treatment

The 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 pressure or kidney failure.

Complications

Acute kidney failure
Chronic bilateral obstructive uropathy
High blood pressure
Reflux nephropathy
Urinary tract infection
Urinary retention or incontinence

Calling your health care provider

Call your health care provider if you have decreased urine output, difficulty urinating, flank pain, or other symptoms of acute bilateral obstructive uropathy.

Prevention

You 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.

References

Wein AJ. Campbell - Walsh Urology. 9th ed. St. Louis, Mo: WB Saunders; 2007.

Goldman L, Ausiello D. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa: WB Saunders; 2004:741-742.

Review Date:1/24/2008
Reviewed By:Marc A. Greenstein, D.O., F.A.C.O.S. Urologist, Somerset Medical Center in Somerville, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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