Obstructive uropathy is a blockage that prevents urine from flowing naturally through the urinary system. The blockage may cause significant pain, nausea, and difficulty urinating.

Several factors can contribute to obstructive uropathy, such as a kidney stone, tumor, and an enlarged prostate.

Early diagnosis and treatment are essential for preventing complications and kidney damage.

Causes of obstructive uropathy

The urinary system includes two kidneys in the lower back and two ureters — long, muscular tubes that drain urine from the kidneys into the bladder. The bladder holds the urine until it is released when it flows through the bladder neck and into the urethra, where it then leaves the body.

Obstructive uropathy develops when a blockage obstructs this natural flow at some point in the urinary system. Blockages may have the following causes:

• Strictures: A stricture is a tube narrowing, similar to a kink. It can occur in the bladder’s neck or ureters.
• Benign prostatic hyperplasia (BPH): BPH is a noncancerous enlargement of the prostate gland that can constrict the urethra. It is common in older males and can make urination difficult.
• Kidney stones: Kidney stones are hard deposits that form in the kidneys and can obstruct flow by lodging in the ureters or urethra.
• Pregnancy: The growing uterus can put pressure on the bladder, making urination difficult.
• Uterine prolapse: When the uterus descends or prolapses into the vagina, it can press on the urinary tract.
• Tumor: Tumors of the urinary tract or surrounding organs, such as the prostate in males, can obstruct urine flow by pressing on the bladder or urethra.

Symptoms of obstructive uropathy

Symptoms of obstructive uropathy can vary slightly depending on the location, underlying cause, and severity of the blockage.

The classic symptoms of obstructive uropathy are:

• difficulty urinating
• a weak urine stream
• intermittent urine flow

Some people experience more urinating at night, a condition known as nocturia. In severe cases, individuals may not be able to urinate at all.

Other common signs include flank pain, which is a pain in the side that often radiates to the lower abdomen or groin.

Some people may experience nausea and vomiting due to the severity of the pain.

Obstructive uropathy also increases the risk of urinary tract infections (UTIs), leading to symptoms such as:

• pain or burning during urination
• foul-smelling urine
• blood in the urine

Diagnosis of obstructive uropathy

Generally, diagnosing obstructive uropathy involves

• reviewing a person’s medical history
• a physical examination
• diagnostic tests

The medical history may reveal the trend of difficulty urinating and any possible causes. These include a previous history of kidney stones, BPH, or urinary surgeries that may cause the blockage.

A physical exam may reveal abdominal or back tenderness and a firm bladder.

Lab tests, including urinalysis and urine culture, can help assess kidney function and detect signs of infection.

Imaging studies, such as an ultrasound or a CT scan of the pelvis, may provide information about the source of the blockage.

Treatment of obstructive uropathy

Treating obstructive uropathy focuses on relieving the blockage and addressing the underlying cause.

In many cases, the first step is to drain the urine and reduce pressure on the urinary tract by inserting a foley catheter — a thin tube that passes through the urethra into the bladder.

If an infection is present, the healthcare professional may prescribe antibiotics to treat it.

If BPH is constricting the flow of urine, certain medications can help relax the smooth muscles of the prostate, making it easier to urinate.

For more complex cases, procedures such as stents and drains may be necessary. Stents are small tubes that doctors insert into the ureters to keep them open and allow urine to pass.

Doctors can place drains, such as nephrostomy tubes, directly from the kidneys to bypass the blockage and drain urine externally.

Treating kidney stones may involve shock wave lithotripsy, which uses sound waves to break up the stones. Ureteroscopy is a procedure where a doctor inserts a small scope into the ureter to break up the stone.

Possible complications of obstructive uropathy

Without treatment, obstructive uropathy can be very painful and lead to serious complications. The most concerning complication is permanent kidney damage due to hydronephrosis, which is when urine backs up into the kidneys.

Prompt diagnosis and treatment can help prevent complications and preserve kidney health.

Obstruction also increases the risk Trusted Source of UTIs, which can further damage the kidneys and may spread to the bloodstream, causing sepsis — a life threatening condition.

Prevention of obstructive uropathy

While it is not always possible to prevent obstructive uropathy, certain lifestyle modifications and preventive measures may reduce the risk.

Staying well-hydrated by drinking plenty of water helps dilute urine and prevent the formation of kidney stones.

Managing existing conditions, such as BPH, through regular checkups and appropriate treatments can help prevent obstruction.

Females can perform pelvic floor exercises to strengthen the muscles supporting the bladder and uterus to prevent uterine prolapse.

Being aware of the symptoms of obstructive uropathy and seeking prompt medical attention can help prevent serious complications.

When to contact a doctor

An individual needs to seek immediate medical attention if they experience the following symptoms:

• a severe or sudden onset of pain at the sides
• painful urination or difficulty passing urine
• blood in the urine
• nausea and vomiting that accompany flank pain
• inability to urinate or decreased urine output

Outlook

The outlook for obstructive uropathy depends on several factors, including the underlying cause, the severity of the obstruction, and the timeliness of the treatment.

Prompt diagnosis and management typically result in a favorable outlook.

However, delaying treatment for an extended period can lead to kidney damage and, potentially, kidney failure.

Summary

Obstructive uropathy is when a blockage hinders urine flow through the urinary system. It can stem from several causes, such as kidney stones, an enlarged prostate, or tumors.

Symptoms range from flank pain, painful urination, and difficulty urinating.

Early diagnosis and treatment generally lead to a positive outlook, while delays can result in complications, such as kidney damage.

Seeking immediate medical attention for symptoms of obstructive uropathy is vital for a positive outlook.