What are the other Names for this Condition? (Also known as/Synonyms)

• Chronic Bilateral Obstructive Uropathy
• Chronic Unilateral Obstructive Uropathy
• Chronic Urinary Tract Obstruction

What is Chronic Obstructive Uropathy? (Definition/Background Information)

• Chronic Obstructive Uropathy is a condition characterized by slowly developing obstruction in the urinary tract (at the kidneys, ureters, bladder outlet, or urethra), eventually resulting in an obstruction to the flow of urine. The obstruction can occur in one urinary tract or may involve both tracts simultaneously
• The most common cause for Chronic Obstructive Uropathy, which generally affects men, is benign prostatic hyperplasia (BPH), a condition in which there is enlargement of the prostate gland. Other possible causes may include stones and cancers of the urinary tract (kidneys, ureters, bladder and urethra)
• The common signs and symptoms associated with Chronic Obstructive Uropathy include increased urinary frequency, frequent urination at night, painful urination, abdominal or back pain. The condition may be diagnosed through ultrasound scan of the kidneys and bladder, abdominal CT scan, and blood tests to check the kidney function
• Kidney failure, a significant complication of Chronic Obstructive Uropathy can be potentially avoided by prompt diagnosis and treatment. Otherwise, it may progress to chronic renal failure, which may require dialysis or renal transplant
• Treatment of the underlying cause of Chronic Obstructive Uropathy is important. This can also help avoid long-term complications

Who gets Chronic Obstructive Uropathy? (Age and Sex Distribution)

• Chronic Obstructive Uropathy can affect any individual of any age group, but it is more common in the older adults due to the increased prevalence (commonness) of tumors, surgeries, and other medical complications in this age group
• The condition is also more common in males than females, due to the fact that the urethra (tube connecting bladder to the exterior) is longer in males, and also because prostate enlargement, one of the important causative factors of Chronic Obstructive Uropathy, is a common health problem in older males
• This urinary tract disorder is seen worldwide, with no racial or ethnic predilection being observed

What are the Risk Factors for Chronic Obstructive Uropathy? (Predisposing Factors)

The risk factors associated with Chronic Obstructive Uropathy include:

• Elderly male: Due to an increased occurrence of benign prostatic enlargement in this age group
• Presence of kidney or ureteral  stones that remained untreated
• Urinary bladder stones
• Cancers of the urinary tract (including the kidney, ureter, and bladder)
• Presence of cystocele in women; cystocele is the bulging of bladder into the vagina
• Presence of rectocele in women; rectocele is the bulging of rectum into the vagina

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chronic Obstructive Uropathy? (Etiology)

Chronic Obstructive Uropathy commonly occurs due to factors that affect the flow of urine through the urinary tract.

• Urine forms in the kidneys and then it passes through the ureters (tubes connecting the kidneys to the urinary bladder) to the urinary bladder. Urine gets stored in the urinary bladder and when it reaches a certain amount, an individual feels the urge to pass urine
• The urethra is a small tube which connects the bladder to the outside of the body and is responsible for draining the urine out of the body. Any interruption in the above drainage system of the urine results in Chronic Obstructive Uropathy

Common causes of Chronic Obstructive Uropathy may include:

• Benign enlargement of prostate in males
• Prostate cancer in males
• Cancers of uterus and cervix in females
• The presence of stones in the kidneys, ureters, urinary bladder, and urethra
• Presence of blood clot in the urinary tract
• Cancers of the kidney, ureter, and bladder
• Ureteral injuries from previous abdominal surgery
• Any trauma to the urinary tract

Fibrosis or cancer in the retroperitoneum (the area present behind the abdomen): The presence of any mass, such as cancer or fibrosis, in this region may affect the urine flow through the ureters

Urethral stricture: Narrowing of the urethra, typically resulting from previous surgeries or recurrent infections

What are the Signs and Symptoms of Chronic Obstructive Uropathy?

The signs and symptoms of Chronic Obstructive Uropathy may include:

• Increased urinary frequency/urgency
• Increased urination at night
• Abdominal or flank (upper abdomen or back) pain
• Back pain
• Blood in the urine
• Pain while urination

Additionally, there may be signs and symptoms of underlying conditions that causes Chronic Obstructive Uropathy.

How is Chronic Obstructive Uropathy Diagnosed?

The following procedures may be used to diagnose Chronic Obstructive Uropathy:

• Thorough evaluation of the individual’s medical history and a complete physical examination of the skin, heart, abdomen, rectum, and vagina
• During history taking, the physician may want to know the following:
  • When the symptoms began and whether they are becoming worse
  • List of prescription and over-the-counter medications currently being taken
  • One’s personal and family history of kidney disease, stones, prostate-related problems, etc.        
• The physical examination may reveal the following:
  • Enlarged bladder
  • Enlarged prostate
  • Mass (tumor) of the kidney, prostate, and cervix
  • Flank tenderness
  • Increase in blood pressure        

  • Abnormal sounds from the lungs (also called rales), due to excess accumulation of fluid in the body

• Ultrasound imaging of the kidneys and bladder is the preferred test for detecting urinary tract obstruction.
• Ultrasound imaging of the kidneys and bladder is the preferred test for detecting urinary tract obstruction. When an ultrasound scan is inconclusive, a CT or MRI scan of the abdomen and pelvis may be used
• Intravenous pyelogram (imaging of kidneys done after injecting a contrast dye that shows swelling of kidneys and urinary tract) is an alternate test; but, this test is rarely performed
• Laboratory tests to find the cause and monitor the kidney function include:
  • Blood urea nitrogen
  • Serum creatinine ratio
  • Creatinine clearance
  • Serum potassium and other electrolytes
  • Fractional excretion of sodium (FENa)         
  • Urine sodium and osmolality
• Other tests depending on the history and physical examination findings
• EKG or ECG (electrocardiogram) may also be taken, especially to monitor electrolyte imbalances that may cause abnormal heart rhythms, which may likely become fatal

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chronic Obstructive Uropathy?

The complications of Chronic Obstructive Uropathy include:

• Renal failure (which could be a permanent problem)
• High blood pressure (hypertension)
• Urinary tract infections

How is Chronic Obstructive Uropathy Treated?

The main goal for treatment is to promptly relieve the obstruction to prevent kidney damage. The treatment options of Chronic Obstructive Uropathy may include:

• Stents/drains are placed in the ureter to provide short-term relief from the symptoms
• Nephrostomy tube can also be placed in the kidneys to relief the obstruction. A nephrostomy tube drains urine from the kidney into a collecting bag outside the body
• Definitive procedures to treat the underlying cause can be done at a later date. These procedures may include:
  • Trans urethral resection of prostate (TURP), which is the removal of prostate through the urethra
  • Appropriate treatment of the cancers responsible for causing the obstruction, using appropriate available modalities
  • Surgery to relieve other causes of obstruction        

How can Chronic Obstructive Uropathy be Prevented?

Most cases of Chronic Obstructive Uropathy cannot be prevented, since this normally occurs due to some underlying acquired health conditions. However, in some situations it can be prevented to a certain extent.

• Proper treatment of the underlying conditions, before it gives rise to complications
• In an individual with benign prostatic hyperplasia, certain medications can improve the flow of urine through an enlarged prostate and prevent Chronic Obstructive Uropathy
• Drink plenty of water, if you are prone to kidney stone formation

What is the Prognosis of Chronic Obstructive Uropathy? (Outcomes/Resolutions)

• If Chronic Obstructive Uropathy is relieved or treated immediately and appropriately, the kidneys resume their function uneventfully
• If the obstruction is left untreated for a long time, there may be permanent damage to the kidneys
• Treatment of underlying cause is needed  to prevent long-term damage to the kidneys and recurrence of the condition

Additional and Relevant Useful Information for Chronic Obstructive Uropathy:

Chronic Obstructive Uropathy can be unilateral (only one kidney is affected, as only one ureter is blocked) or bilateral (when both kidneys are affected due to poor drainage by the ureters). The bilateral condition is rare, but more serious and requires urgent treatment.