genitourinary disorders
Obstructive Uropathy
Treatment of Obstructive Uropathy
Relief of obstruction Treatment consists of eliminating the obstruction by surgery, instrumentation (eg, endoscopy, lithotripsy), or drug therapy (eg, hormonal therapy for prostate cancer). Prompt drainage of hydronephrosis is indicated if renal function is compromised, urinary tract infection (UTI) persists, or pain is uncontrollable or persistent. Immediate drainage is indicated if obstruction is accompanied by infection. Lower obstructive uropathy may require catheter or more proximal drainage. Indwelling ureteral catheters can be placed for acute or long-term drainage in selected patients. Temporary drainage using a percutaneous nephrostomy technique may be needed in severe obstructive uropathy, UTI, or calculi. Intensive treatment for UTI and renal failure is imperative. In the case of hydronephrosis without evident obstruction, surgery should be considered if the patient has pain and a positive diuretic renogram. However, no therapy is necessary in an asymptomatic patient with a negative diuretic renogram or with a positive diuretic renogram but normal renal function. 