Acute bilateral obstructive uropathy

Alternative names:

acute urethral obstruction; obstructive uropathy - bilateral - acute; urethral obstruction

Definition:

A disorder involving sudden blockage of the flow of urine out of the bladder and urethra, which may result in the backup of urine and injury to 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 does not drain properly because of an obstruction. Pressure in the urinary tract rises, resulting 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 acute renal failure. Sudden blockage causes acute bilateral obstructive uropathy, while slow progressive blockage causes chronic bilateral obstructive uropathy.

Acute bilateral obstructive uropathy is caused by obstruction of the urethra that occurs suddenly or over a short time. In men, it is most often a result of an enlarged prostate. It is much less common in women but can occur as a result of bladder cystocele. Other causes include bladder tumors, tumors of the prostate (see prostate cancer), and tumors or other structures around the bladder neck or urethra, especially if the tumors grow quickly and by strictures in any part of the genito-urinary tract. A history of kidney stones or bladder stones increases the risk of acute bilateral obstructive uropathy.

Initially, the bladder reacts to the obstruction through 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 (see UTI - acute). Urine may back up into the ureters and kidney. Symptoms develop because of urinary retention and/or damage to the bladder, ureters, and kidneys from backup (reflux) of urine.

Acute bilateral obstructive uropathy occurs in about 5 out of 10,000 people.