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Highlights & Basics
- Obstructive uropathy is blockage of urinary flow, which can occur at any level in the urinary tract. It may affect one or both kidneys, depending on the level of obstruction.
- A number of underlying conditions can result in obstructive uropathy, most commonly urolithiasis, ureteropelvic junction obstruction, and benign prostatic hyperplasia.
- Initial treatment in the acute setting is directed at relieving pressure on the kidneys to prevent irreversible renal damage. This may involve a urethral catheter, ureteric stent, or nephrostomy tube, depending on the level and cause of obstruction.
- Subsequent treatment is targeted toward treating the underlying cause.
- Infection within an obstructed system must be treated promptly.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Wessells H, Morey A, Souter L, et al. Urethral stricture disease guideline amendment (2023). J Urol. 2023 Jul;210(1):64-71.[Abstract][Full Text]
American College of Radiology. ACR appropriateness criteria: acute onset flank pain-suspicion of stone disease (urolithiasis). 2023 [internet publication].[Full Text]
Sandhu JS, Bixler BR, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA guideline amendment 2023. J Urol. 2024 Jan;211(1):11-19.[Abstract][Full Text]
European Association of Urology. EAU guidelines on urolithiasis. 2024 [internet publication].[Full Text]
American Urological Association; Endourological Society. Surgical management of stones: AUA/Endourology Society guideline. 2016 [internet publication].[Full Text]
1. Klahr S. Obstructive nephropathy. Intern Med. 2000 May;39(5):355-61.[Abstract][Full Text]
2. Scales CD Jr, Smith AC, Hanley JM, et al. Prevalence of kidney stones in the United States. Eur Urol. 2012 Jul;62(1):160-5.[Abstract][Full Text]
3. Sorokin I, Mamoulakis C, Miyazawa K, et al. Epidemiology of stone disease across the world. World J Urol. 2017 Sep;35(9):1301-20.[Abstract]
4. Liu Y, Chen Y, Liao B, et al. Epidemiology of urolithiasis in Asia. Asian J Urol. 2018 Oct;5(4):205-14.[Abstract][Full Text]
5. Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010 Spring;12(2-3):e86-96.[Abstract][Full Text]
6. Fakheri RJ, Goldfarb DS. Ambient temperature as a contributor to kidney stone formation: implications of global warming. Kidney Int. 2011 Jun;79(11):1178-85.[Abstract][Full Text]
7. Patel ND, Parsons JK. Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian J Urol. 2014 Apr;30(2):170-6.[Abstract][Full Text]
8. Gild P, Kluth LA, Vetterlein MW, et al. Adult iatrogenic ureteral injury and stricture-incidence and treatment strategies. Asian J Urol. 2018 Apr;5(2):101-6.[Abstract][Full Text]
9. Yaxley J, Yaxley W. Obstructive uropathy - acute and chronic medical management. World J Nephrol. 2023 Jan 25;12(1):1-9.[Abstract][Full Text]
10. American Urological Association. Non-neurogenic chronic urinary retention: consensus definition, management strategies, and future opportunities. 2016 [internet publication].[Full Text]
11. McConnell JD, Roehrborn CG, Bautista OM, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003 Dec 18;349(25):2387-98.[Abstract][Full Text]
12. Lemieux MC, Kamm MA, Fowler CJ. Bowel dysfunction in young women with urinary retention. Gut. 1993 Oct;34(10):1397-9.[Abstract][Full Text]
13. Choong S, Emberton M. Acute urinary retention. BJU Int. 2000 Jan;85(2):186-201.[Abstract][Full Text]
14. Verhamme KM, Sturkenboom MC, Stricker BH, et al. Drug-induced urinary retention: incidence, management and prevention. Drug Saf. 2008;31(5):373-88.[Abstract]
15. Chevalier RL. Obstructive nephropathy: towards biomarker discovery and gene therapy. Nat Clin Pract Nephrol. 2006 Mar;2(3):157-68.[Abstract]
16. Rule AD, Jacobson DJ, Roberts RO, et al. The association between benign prostatic hyperplasia and chronic kidney disease in community-dwelling men. Kidney Int. 2005 Jun;67(6):2376-82.[Abstract]
17. Jendeberg J, Geijer H, Alshamari M, et al. Size matters: The width and location of a ureteral stone accurately predict the chance of spontaneous passage. Eur Radiol. 2017 Nov;27(11):4775-85.[Abstract][Full Text]
18. De Seze M, Ruffion A, Denys P, et al. The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines. Mult Scler. 2007 Aug;13(7):915-28.[Abstract]
19. Organ M, Norman RW. Acute reversible kidney injury secondary to bilateral ureteric obstruction. Can Urol Assoc J. 2011 Dec;5(6):392-6.[Abstract][Full Text]
20. Fiadjoe P, Kannan K, Rane A. Maternal urological problems in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2010 Sep;152(1):13-7.[Abstract][Full Text]
21. Neulander EZ, Kaneti J, Klain J, et al. Obstructive uropathy secondary to inguinal bladder hernia: case report and review of the literature. Can J Urol. 2007 Dec;14(6):3761-3.[Abstract]
22. Yee DS, Ahlering TE, Gelman J et al. Fossa navicularis strictures due to 22F catheters used in robotic radical prostatectomy. JSLS. 2007 Jul-Sep;11(3):321-5.[Abstract]
23. Wessells H, Morey A, Souter L, et al. Urethral stricture disease guideline amendment (2023). J Urol. 2023 Jul;210(1):64-71.[Abstract][Full Text]
24. Demko TM, Diamond JR, Groff J. Obstructive nephropathy as a result of retroperitoneal fibrosis: a review of its pathogenesis and associations. J Am Soc Nephrol. 1997 Apr;8(4):684-8.[Abstract]
25. American College of Radiology. ACR appropriateness criteria: acute onset flank pain-suspicion of stone disease (urolithiasis). 2023 [internet publication].[Full Text]
26. Ripolles T, Agramunt M, Errando J, et al. Suspected ureteral colic: plain film and sonography vs unenhanced helical CT. A prospective study in 66 patients. Eur Radiol. 2004 Jan;14(1):129-36.[Abstract]
27. European Association of Urology. Guidelines on urological infections. 2024 [internet publication].[Full Text]
28. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10.[Abstract][Full Text]
29. Capolicchio JP, Braga LH, Szymanski KM. Canadian Urological Association/Pediatric Urologists of Canada guideline on the investigation and management of antenatally detected hydronephrosis. Can Urol Assoc J. 2018 Apr;12(4):85-92.[Abstract][Full Text]
30. Choi YH, Cheon JE, Kim WS, et al. Ultrasonography of hydronephrosis in the newborn: a practical review. Ultrasonography. 2016 Jul;35(3):198-211.[Abstract][Full Text]
31. Epelman M, Victoria T, Meyers KE, et al. Postnatal imaging of neonates with prenatally diagnosed genitourinary abnormalities: a practical approach. Pediatr Radiol. 2012 Jan;42 Suppl 1:S124-41.[Abstract][Full Text]
32. European Association of Urology. Non-neurogenic female LUTS. 2023 [internet publication].[Full Text]
33. European Association of Urology. Management of non-neurogenic male LUTS. 2024 [internet publication].[Full Text]
34. American College of Radiology. ACR appropriateness criteria: hydronephrosis on prior imaging-unknown cause. 2023 [internet publication].[Full Text]
35. American College of Radiology. ACR appropriateness criteria: acute onset flank pain-suspicion of stone disease (urolithiasis). 2023 [internet publication].[Full Text]
36. Little P, Turner S, Rumsby K, et al. Developing clinical rules to predict urinary tract infection in primary care settings: sensitivity and specificity of near patient tests (dipsticks) and clinical scores. Br J Gen Pract. 2006 Aug;56(529):606-12.[Abstract][Full Text]
37. Herbst MK, Rosenberg G, Daniels B, et al. Effect of provider experience on clinician-performed ultrasonography for hydronephrosis in patients with suspected renal colic. Ann Emerg Med. 2014 Sep;64(3):269-76.[Abstract][Full Text]
38. Gliga ML, Chirila CN, Podeanu DM, et al. Twinkle, twinkle little stone: an artifact improves the ultrasound performance!. Med Ultrason. 2017 Jun 17;19(3):272-75.[Abstract][Full Text]
39. Sandhu JS, Bixler BR, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA guideline amendment 2023. J Urol. 2024 Jan;211(1):11-19.[Abstract][Full Text]
40. European Association of Urology. EAU guidelines on non-neurogenic male lower urinary tract symptoms (LUTS). 2024 [internet publication].[Full Text]
41. European Association of Urology. EAU guidelines on urolithiasis. 2024 [internet publication].[Full Text]
42. American Urological Association; Endourological Society. Surgical management of stones: AUA/Endourology Society guideline. 2016 [internet publication].[Full Text]
43. Goldsmith ZG, Oredein-McCoy O, Gerber L, et al. Emergent ureteric stent vs percutaneous nephrostomy for obstructive urolithiasis with sepsis: patterns of use and outcomes from a 15-year experience. BJU Int. 2013 Jul;112(2):E122-8.[Abstract][Full Text]
44. American College of Radiology. ACR appropriateness criteria: radiologic management of urinary tract obstruction. 2019 [internet publication].[Full Text]
45. Ku JH, Lee SW, Jeon HG, et al. Percutaneous nephrostomy versus indwelling ureteral stents in the management of extrinsic ureteral obstruction in advanced malignancies: are there differences? Urology. 2004 Nov;64(5):895-9.[Abstract]
46. Hollingsworth JM, Canales BK, Rogers MA, et al. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ. 2016 Dec 1;355:i6112.[Abstract][Full Text]
47. Aboumarzouk OM, Kata SG, Keeley FX, et al. Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Cochrane Database Syst Rev. 2012 May 16;(5):CD006029.[Abstract][Full Text]
48. Kouba E, Wallen EM, Pruthi RS. Management of ureteral obstruction due to advanced malignancy: optimizing therapeutic and palliative outcomes. J Urol. 2008 Aug;180(2):444-50.[Abstract]
49. New F, Deverill S, Somani BK. Role of percutaneous nephrostomy in end of life prostate cancer patients: a systematic review of the literature. Cent European J Urol. 2018;71(4):404-9.[Abstract][Full Text]
50. National Institute for Health and Care Excellence. Prostate cancer: diagnosis and management. Dec 2021 [internet publication].[Full Text]
51. Huang SW, Tsai CY, Tseng CS, et al. Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis. BMJ. 2019 Nov 14;367:l5919.[Abstract][Full Text]
52. Emberton M, Fitzpatrick JM. The Reten-World survey of the management of acute urinary retention: preliminary results. BJU Int. 2008 Mar;101 Suppl 3:27-32.[Abstract]
53. Lee EH, Kim SH, Shin JH, et al. Effects on renal outcome of concomitant acute pyelonephritis, acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis: a retrospective cohort study. BMJ Open. 2019 Nov 3;9(11):e030438.[Abstract][Full Text]
54. Bao Y, Tu X, Wei Q. Water for preventing urinary stones. Cochrane Database Syst Rev. 2020 Feb 11;(2):CD004292.[Abstract][Full Text]
55. Agarwal MM, Singh SK, Mavuduru R, et al. Preventive fluid and dietary therapy for urolithiasis: An appraisal of strength, controversies and lacunae of current literature. Indian J Urol. 2011 Jul;27(3):310-9.[Abstract][Full Text]
