Chronic bilateral obstructive uropathy

Alternative names:

chronic urethral obstruction; obstructive uropathy - bilateral - chronic; urethral obstruction - chronic

Definition:

A disorder that involves prolonged or progressive blockage of the flow of urine from both kidneys.

Causes, incidence, and risk factors:

Obstructive uropathy occurs when the flow of urine is blocked. The kidneys produce urine in the normal manner but the urine cannot leave the bladder because of an obstruction. Urine may back up behind the obstruction and damage the structures of the urinary tract.

When the obstruction is located so that urine backs up into both kidneys, the damage results in hydronephrosis (distention of the kidney pelvis and calyces) and bilateral obstructive uropathy (damage to both kidneys caused by obstruction of urine). Obstructive uropathy can eventually lead to hypertension and/or renal failure. Sudden blockage causes acute bilateral obstructive uropathy, while slow progressive blockage causes chronic bilateral obstructive uropathy.

Chronic bilateral obstructive uropathy is caused by gradual obstruction of both ureters or the bladder or urethra, resulting in a back-up of urine into both kidneys. In men, this is most often as a result of a benign enlargement of the prostate. It is much less common in women, but can occur as a result of bladder cystocele.

Other causes include bladder tumors, prostate tumors, and tumors or masses (aggregations of cells) of the uterus or other structures around the bladder neck or urethra, including retroperitoneal fibrosis. Narrowing of the urethra may be caused by congenital deformity or scar tissue from injury or infection.

Initially, the bladder reacts to the obstruction by increased irritability. There is a stronger and more frequent urge to urinate, and bladder spasms or incontinence may occur. As urine accumulates, it may lead to stasis of urine and urinary tract infections. Urine backs up into the ureters and kidneys. Symptoms are the result of urinary retention and damage to the bladder, ureters, and kidneys.

Chronic bilateral obstructive uropathy occurs in about 1 out of 1,000 people.