Obstructive Uropathy

Obstructive uropathy is a blockage in your urinary system. To obstruct means to block or impede, and uropathy means a disease or condition that affects your urinary organs.

Obstructive uropathy can make it difficult for pee to leave your body through your urethra. As a result, the pee may flow the wrong way back up to your kidneys and cause kidney damage. It affects about 2 out of every 1,000 people. It’s responsible for about 10% of all cases of chronic kidney disease (CKD).

Another name for obstructive uropathy is urinary blockage.

What are the types of obstructive uropathy?

When obstructive uropathy starts suddenly, healthcare providers call it acute obstructive uropathy. They call it chronic obstructive uropathy when it develops slowly and lasts a long time.

Obstructive uropathy may also affect one kidney (unilateral obstructive uropathy) or both of your kidneys (bilateral obstructive uropathy).

Obstructive uropathy can be partial or complete, as well. Partial obstructive uropathy means the blockage only affects part of your urinary system. Your stream may slow or stop in the middle of peeing. Complete obstructive uropathy fully blocks your urinary system. This means you can’t pee at all.

What are the symptoms of obstructive uropathy?

Obstructive uropathy symptoms affect your peeing habits, including:

• Inability to completely empty your bladder (urinary retention)
• A sudden, uncontrollable urge to pee (urge incontinence)
• Leaking pee (urinary incontinence)
• Difficulty starting to pee or a slow urine flow (urinary hesitancy)
• Peeing less than usual
• Blood in your pee (hematuria)

Other common obstructive uropathy symptoms may include:

• Fever
• Nausea and vomiting
• Flank pain on one or both sides of your body

What does a urinary blockage feel like?

A urinary blockage may cause discomfort or pain in your abdomen or one or both flanks.

What are the main causes of obstructive uropathy?

Some of the most common causes of obstructive uropathy include:

• Kidney stones
• Enlarged prostate (benign prostatic hyperplasia)
• Scarring in your urethra (urethral stricture)
• Scarring in your ureters (ureteral stricture)
• Nerve damage that affects the muscles in and around your bladder

Cancer that affects your urinary system or areas around your urinary system can also cause obstructive uropathy. This may include:

• Bladder cancer
• Cervical cancer
• Colon cancer
• Ovarian cancer
• Prostate cancer
• Ureteral cancer
• Uterine cancer

What are the complications of obstructive uropathy?

Without treatment, pee can build up in your kidneys and cause them to swell (hydronephrenosis). Over time, hydronephrosis can cause your kidneys to stop working on their own (kidney failure).

How is obstructive uropathy diagnosed?

A healthcare provider will ask about your symptoms, review your health history and perform a physical exam. If they suspect you have obstructive uropathy, they’ll order tests to help confirm a diagnosis. These tests may include:

• Urodynamic tests: Urodynamic tests measure how much you pee, the strength and speed of your pee stream and any pressure on your bladder.
• Imaging tests: Imaging tests may include a CT scan, MRI or X-ray.
• Cystoscopy: A provider uses a special instrument (cystoscope) to look through your urethra into your bladder.
• Voiding cystourethrogram (VCUG): A VCUG is an imaging test that looks at your bladder as it fills with fluid and drains when you pee.
• Renal scan: A renal scan is a type of nuclear medicine test. It uses a small amount of radioactive material to show how blood flows through your kidneys and pee flows through your urinary system.

How do you treat obstructive uropathy?

It depends on the exact cause of obstructive uropathy. A healthcare provider will immediately drain your bladder if you have complete obstructive uropathy and are in a lot of pain. Devices they may use include:

• Foley catheter: A provider inserts a thin, flexible tube through your urethra and into your bladder to drain pee into a bag outside your body.
• Nephrostomy tubes: A provider inserts small catheters directly into your kidney through your back.

If scarring causes obstructive uropathy, a provider may use:

• Ureteral stents: Ureteral stents are thin tubes that hold your ureters open.
• Urethral dilation: A surgeon uses thin rods (sounds) or a balloon to widen your urethra gradually.

Medications can treat an enlarged prostate.

In severe cases, a surgeon may remove your kidney (nephrectomy) or prostate (prostatectomy).

When should I see a healthcare provider?

See a healthcare provider if you have changes to your peeing habits, especially if they appear along with pain in one or both of your flanks or abdomen.

During your appointment, you may wish to ask the following questions:

• How do you know I have obstructive uropathy?
• What’s causing obstructive uropathy?
• What’s your recommended treatment?
• How soon after treatment will I feel better?

When should I go to the ER?

Go to the nearest emergency room if you have any of the following symptoms:

• Inability to pee at all
• Increasing or unbearable pain while peeing
• Blood in your pee
• Signs of an infection, including a fever or chills, along with any one of the above symptoms

What can I expect if I have obstructive uropathy?

If obstructive uropathy develops suddenly and you get treatment quickly, your outlook is usually good. You likely won’t have permanent kidney damage. You’re also less likely to have long-term kidney problems if obstructive uropathy only affects one of your kidneys — most people can live with one healthy kidney with few or no problems.

You may have permanent kidney damage if obstructive uropathy affects both of your kidneys and there’s a delay in treatment. If your kidneys no longer function well on their own, you’ll need treatment that filters your blood (dialysis) or a kidney transplant.

Can obstructive uropathy be prevented?

You can help prevent obstructive uropathy by getting treatment for any conditions that may cause it. And you can help prevent some of these conditions by:

• Avoiding tobacco products: This includes smoking, vaping and smokeless tobacco. If you currently use tobacco products, it’s a good idea to quit.
• Cancer screening: A healthcare provider will look for signs of cancer before you show any symptoms.
• Eating healthy foods every day: Eat lots of fruits and vegetables and cut back on processed foods, red meat, sugar and salt.
• Drinking plenty of water: The average person should drink at least 64 oz. (8 cups) of water each day.
• Being active: You should be active (such as aerobic exercise) for at least 30 minutes five days a week.
• Taking your medications: Be sure to take your medications exactly as prescribed by a healthcare provider.

What is the difference between obstructive uropathy and vesicoureteral reflux?

Vesicoureteral reflux (VUR) is a type of obstructive uropathy. It mostly affects children under the age of 2. Causes may include:

• A congenital condition that occurs during fetal development or very early in infancy
• A blockage or narrowing in your child’s bladder or urethra