Obstructive uropathy - bilateral - chronic; Kidney failure - chronic blockage
Chronic bilateral obstructive uropathy is a long-term blockage of urine flow from both kidneys. It is a slow blockage that gets worse over time.
Bilateral means "both sides."
The most common cause of chronic bilateral obstructive uropathy is a condition called bladder outlet obstruction. The kidneys produce urine in the normal manner but the urine cannot leave the bladder. Urine backs up, causing kidney swelling and damage.
When the blockage causes urine to back up into both kidneys, hydronephrosis (swelling of the kidneys) results. High blood pressure and kidney failure can result.
In men, chronic bilateral obstructive uropathy is most often a result a result of enlargement of the prostate, also called benign prostatic hyperplasia (BPH).
Other causes of chronic bilateral obstructive uropathy include:
Chronic bilateral obstructive uropathy occurs in about 1 out of every 1,000 people.
Symptoms depend on the nature of the obstruction and where in the urinary tract the obstruction occurs.
Some of the most common symptoms of chronic obstructive uropathy include:
Additional symptoms that may be associated with this disease:
A physical exam may show swollen or tender kidneys. The bladder may be large and full. A rectal examination may reveal an enlarged prostate. Blood pressure may be high.
Blood tests will be done to check kidney function, electrolyte balance, and blood cell counts. Urine tests may reveal a urinary tract infection.
Other tests that may be done:
The goal of treatment is to remove the blockage. You may need to stay in a hospital for a short while.
Treatment may include:
Bilateral obstructive uropathy may be reversible if the blockage is corrected before kidney failure develops.
Chronic kidney failure leads to long-term kidney damage that can be life threatening.
Patients with a chronic blockage are at a higher risk for complications following initial catheter placement. During the first few days following correction of the obstruction, the kidneys may be unable to concentrate urine. As a result, your body removes large amounts of urine that haven't been properly processed. This is called post-obstructive diuresis. It can be a life-threatening condition. Close monitoring is required.
If the obstruction was caused by cancer, the ultimate outcome depends on the disease severity and your response to treatment.
Call your health care provider if decreased urine output or other symptoms of chronic bilateral obstructive uropathy develop.
Routine screening (and treatment) for lower urinary tract disorders may help prevent this condition. A digital rectal exam is used to screen men for prostate problems.
Pais VM Jr, Strandhoy JW, Assimos DG. Pathophysiology of urinary tract obstruction. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 37.
Hsu THS, Streem SB, Nakada SY. Management of upper urinary tract obstruction. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 38.
McAninch JW, Santucci RA. Renal and ureteral trauma. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 39.
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