genitourinary disorders
Obstructive Uropathy
Symptoms and Signs of Obstructive Uropathy
Symptoms and signs vary with the site, degree, and rapidity of onset of obstructive uropathy. Pain is common when obstruction acutely distends the bladder, collecting system (ie, the ureter, renal pelvis, and renal calyces), or renal capsule. Upper ureteral or renal pelvic lesions cause flank pain or tenderness, whereas lower ureteral obstruction causes pain that may radiate to the ipsilateral testis or labium. The distribution of kidney and ureteral pain is usually along T11 to T12. Acute complete ureteral obstruction (eg, an obstructing ureteral calculus) may cause severe pain accompanied by nausea and vomiting. A large fluid load (eg, from drinking alcoholic or caffeinated beverages, or osmotic diuresis due to an IV contrast agent) causes dilation and pain if urine production increases to a level greater than the flow rate through the area of obstruction. Pain is typically minimal or absent with partial or slowly developing obstructive uropathy (eg, congenital ureteropelvic junction obstruction, pelvic tumor). Hydronephrosis may occasionally cause a palpable flank mass, particularly in massive hydronephrosis of infancy and childhood. Urine volume does not diminish in unilateral obstruction unless it occurs in the only functioning kidney (solitary kidney). Absolute anuria occurs with complete obstruction at the level of the bladder or urethra. Partial obstruction at that level may cause difficulty voiding or abnormalities of the urine stream. In partial obstruction, urine output is often normal and is rarely increased. Increased urine output with polyuria and nocturia occur if the ensuing nephropathy causes impaired renal concentrating capacity and sodium reabsorption. Long-standing nephropathy may also result in Hypertension . Infection complicating obstruction may cause dysuria, pyuria, urinary urgency and frequency, referred kidney and ureteral pain, costovertebral angle tenderness, fever, and, occasionally, septicemia. 