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Obstructive uropathy: Blockage of urine flow

Obstructive uropathy is a condition in which the flow of urine is blocked. This causes urine to flow back and causes damage to one or both kidneys. The condition results from, among other things, kidney or bladder stones, certain forms of cancer or scar tissue around the ureters. Various imaging studies provide useful information to the doctor regarding the cause of the blockage of the urine flow. It is possible to correct this blockage in the short term without surgery, but the doctor must also solve the underlying problem and surgical intervention is often necessary. The prospects are good if prompt treatment is given, but otherwise permanent damage to the kidneys may occur.

  • Causes of blockage of urine flow
  • Symptoms
  • General signs
  • Urinary problems
  • Unborn baby
  • Diagnosis and examinations
  • Treatment of obstructive uropathy
  • Prognosis of kidney disease
  • Complications: Severe and permanent damage to kidneys
  • Prevention of blockage of urine flow

 

Causes of blockage of urine flow

Obstructive uropathy occurs when urine cannot drain through the urinary tract. The urine ends up back in the kidney, causing the kidney to swell (hydronephrosis: water kidney).Common causes of obstructive uropathy are:

  • cervical cancer
  • uterine cancer
  • bladder or ureteral cancer
  • bladder stones
  • blood clots
  • colon cancer
  • a pelvic fracture or other injuries
  • any cancer that spreads (metastases)
  • benign prostatic hyperplasia (enlarged prostate)
  • scar tissue inside or outside the ureters
  • scar tissue in the urethra
  • kidney stones
  • problems with the nerves that supply the bladder
  • some digestive disorders

 

Symptoms

Obstructive uropathy may affect one or both kidneys. The condition comes on suddenly or occurs gradually. The symptoms depend on several factors, including whether one or both kidneys are affected and also whether the blockage occurred suddenly or gradually.

General signs

The following symptoms are possible:

  • weight gain or swelling (edema) of the kidneys (swollen kidneys)
  • a distended abdomen / palpable bladder
  • fever
  • mild to severe pain in the flank (flank pain). the pain is felt on one or both sides
  • nausea or vomiting
  • pain in the ribs

 

Urinary problems

Various urinary problems occur due to kidney disease, such as:

  • inability to empty the bladder completely (urinary retention)
  • a frequent urge to urinate (urinary urgency)
  • a reduction in the force of urine flow
  • dripping urine
  • need to urinate more often at night (nocturia)
  • a reduced amount of urine (oliguria)
  • a leakage of urine (urinary incontinence)
  • blood in the urine (hematuria)

 

Unborn baby

Obstructive uropathy sometimes also affects an unborn fetus. One of the signs of a blockage of urine flow in an unborn baby is a lower level of amniotic fluid in the uterus (oligohydramnios). Urine is one of the components of amniotic fluid. A fetus with obstructive uropathy is unable to urinate outside its body. This leads to a decrease in amniotic fluid volume, resulting in fetal or birth complications.

Diagnosis and examinations

The physician health care provider orders imaging tests to detect obstructive uropathy. Commonly used studies include:

  • a CT scan of the abdomen or pelvic area
  • a cystourethrography
  • an ultrasound scan of the abdomen or pelvic area
  • an intravenous pyelography (this is an examination that the doctor uses to detect abnormalities in the urinary tract)
  • an MRI scan
  • a nuclear scan of the kidneys

 

Treatment of obstructive uropathy

The doctor may place a stent or drain in the ureter or in the renal pelvis (part of the kidney). This treatment relieves symptoms in the short term. The doctor sometimes uses nephrostomy tubes, which drain urine from the kidneys through the back, to bypass the blockage. The doctor sometimes also uses a Foley catheter to promote urine flow. The doctor places this catheter in the bladder via the urethra. It is therefore possible to relieve the blockage in the short term without surgery, but it is important to address and remove the cause of the blockage, as well as to repair the urinary system. Therefore, surgery is often necessary in the long term to solve the problem, such as to remove a tumor. If the blockage causes serious loss of function, it is sometimes necessary to remove the kidney (nephrectomy).

Prognosis of kidney disease

If the blockage occurs suddenly, rapid detection and repair is necessary so that no (permanent) kidney damage occurs. Often, any damage to the kidneys goes away when the patient receives prompt treatment. If the blockage has been present for a long time, the patient will suffer from damage to the kidneys. If only one kidney is damaged, chronic kidney problems are less likely to manifest themselves. A patient may need kidney dialysis or a kidney transplant if there is damage to both kidneys and the kidneys no longer function properly, even after treatment.

Complications: Severe and permanent damage to kidneys

Obstructive uropathy can cause permanent and severe damage to the kidneys, resulting in renal failure. If the problem was caused by a blockage in the bladder, long-term bladder damage may also occur . This leads to problems emptying the bladder or leaking urine (urinary incontinence). Obstructive uropathy is further linked to higher chances of urinary tract infections.

Prevention of blockage of urine flow

It is important to treat conditions that may lead to obstructive uropathy. This way it is possible to prevent the disease.

read more

  • Bladder stones: Hard deposits of minerals in the bladder
  • Kidney stones: Formation of crystals with pain in the abdomen and back
  • Renal failure: Decreased or absent renal function
  • Urinary problems (micturition difficulties): Problems with urination