Obstructive uropathy is a condition in which the flow of urine is blocked. Urine backs up and can cause injury to one or both kidneys.
Uropathy - obstructive
Obstructive uropathy occurs when urine cannot drain through a ureter. The ureter is a tube that carries urine from the kidneys to the bladder. Urine backs up into the kidney and causes it to become swollen (hydronephrosis).
Obstructive uropathy can affect one or both kidneys. It can occur suddenly, or be a long-term problem.
Common causes of obstructive uropathy include:
- Bladder stones
- Kidney stones
- Benign prostatic hyperplasia (enlarged prostate)
- Bladder or ureteral cancer
- Colon cancer
- Cervical cancer
- Uterine cancer
- Any cancer that spreads
- Scar tissue that occurs inside or outside of the ureters
- Problems with the nerves that supply the bladder
Rarely, the problem may occur during pregnancy. This is called idiopathic hydronephrosis of pregnancy.
Symptoms depend on how quickly the problem starts and whether one or both kidneys are involved. Symptoms may include:
- Mild to severe pain in the upper back (flank pain). Pain may be felt on one or both sides
- Nausea or vomiting
- Weight gain or swelling (edema)
You may also have problems passing urine, such as:
- Urge to urinate often or frequency of urination
- Decrease in the force of urine stream
- Dribbling of urine
- Not feeling as if the bladder is emptied
- Need to urinate more often at night
- Decreased amount of urine
- Blood in urine
Exams and Tests
Imaging studies are used to make the diagnosis. These commonly include:
- Ultrasound of the belly area (abdomen) or pelvis
- CT scan of the belly area (abdomen) or pelvis
- Intravenous pyelogram (IVP)
- Voiding cystourethrogram
- Renal nuclear scan
Stents or drains placed in the ureter or in a part of the kidney called the renal pelvis may provide short-term relief of symptoms.
Nephrostomy tubes, which drain urine from the kidneys out of the body into a drainage bag, may be used to bypass the blockage.
A Foley catheter placed through the urethra into the bladder may also be helpful.
Short-term relief can be achieved without surgery. However, the cause of the blockage must be removed and the urinary system repaired. Long-term relief may require surgery.
Kidney damage is less likely if the problem is diagnosed and treated promptly. Often, the damage to the kidneys goes away.
Long-term damage to the kidneys may occur if you have had obstructive uropathy for a long time.
If only one kidney is damaged, chronic kidney problems are less likely.
When both kidneys become damaged and fail to function, even after the obstruction is repaired, you may need dialysis or a kidney transplant.
Obstructive uropathy can cause lasting damage to the kidneys and result in renal failure. If the problem was caused by blockage to the bladder outlet, there can be permanent bladder damage. This can result in problems such as incontinence and urinary retention.
When to Contact a Medical Professional
Contact your health care provider if you have symptoms of obstructive uropathy.
Obstructive uropathy can be prevented by addressing any underlying disorders that can cause it.
Zeidel ML. Obstructive uropathy. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 125.
Singh I, Strandhoy JW, Assimos DG. Pathophysiology of urinary tract obstruction. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 40.
Last reviewed 3/26/2014 by Sovrin M. Shah, MD, Assistant Professor, Department of Urology, Albert Einstein College of Medicine, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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