genitourinary disorders
Obstructive Uropathy
Key Points
Common causes in children include congenital anomalies; in young adults, calculi; and in older men benign prostatic hypertrophy. Consequences can include renal insufficiency and infection. Pain is common when organs are acutely distended in the upper genitourinary tract (commonly felt in the flank) or the bladder (commonly felt in the testes, suprapubic area, or labia). Suspect obstructive uropathy when patients have unexplained renal insufficiency, decreased urine output, pain that suggests obstruction, or oliguria or anuria alternating with polyuria. For suspected lower tract obstruction, catheterize the bladder, then consider cystourethroscopy and, in selected cases, voiding cystourethrography. For suspected upper tract obstruction, do imaging studies (eg, abdominal ultrasonography, CT, duplex Doppler ultrasonography, intravenous pyelography, MRI). Relieve obstruction promptly, particularly if patients also have urinary tract infection. 