Urinary obstruction can occur with problems with the kidney, ureter, bladder or the urethra. The function of kidneys is to make urine. The formed urine than travels to the bladder via the small tube like structures called ureters. The urine is stored in the bladder until it is emptied. Urine does not normally pass out of the bladder because of the presence of the urethra, which acts like a valve. When one feels a sensation of a full bladder, the urethra relaxes and the bladder contracts.
Causes
Hospital data indicate that urinary obstructions occur in 1 out of every 1000 people. One of the most common causes of urinary obstruction is benign prostatic hypertrophy (BPH). Other causes of urinary obstructions include:
Defects acquired at birth- kinked ureters, abnormally shaped urethra or angulations of bladder
Scarring or stricture of ureter from prior infection or surgery
Kidney stones
Cancers of the urinary system
Cancers of the colon, uterus
Any other metastatic cancer
Symptoms
Urinary obstruction may involve both kidneys or may affect only one kidney or ureter. Symptoms of a urinary obstruction include:
Inability to pass urine
Weak stream
Interrupted urine flow
Blood in the urine
Pain in the sides or lower back
Distension of the lower abdomen near the pubic
Diagnosis
The diagnosis of a urinary obstruction must be prompt to prevent irreversible damage. The basic tests include urinary analysis, x rays and a variety of urodynamic studies. Other studies do look at the kidney include CT scan or MRI.
Treatment
The treatment of urinary obstruction depends on the location.
The goal of all urinary obstruction treatment is to clear the blockage and restore normal urine flow.
Short term treatment
When there is an acute obstruction with urinary retention, immediately relief can be provided by placing a small catheter into the bladder from the urethra. Sometimes there may be narrow stricture or scar in the ureter that may be causing the urinary obstruction. This can be opened up by placing a stent (hollow tube) to keep the ureter open.
Sometime a nephrostomy tube can be placed using x rays. This involves placing a small tube from the lower back directly into the kidney under ultrasound; the procedure is done under local anesthesia and provides good relief of symptoms.
Cystoscopy utilizes a small flexible tube with a camera; the tube can be inserted from the urethra all the way to the bladder. The system can also be used to excise masses, biopsy and perform minor surgery. Often small kidney stones can be removed with this procedure.
If benign prostatic hypertrophy is the cause of urinary obstruction, the most common procedure performed is known as transurethral resection of the prostate or TURP. This procedure is done with a cystoscope to visualize the prostate and the enlarged tissues are removed. Sometimes the procedure can be used with a laser to core out the blockage
Long term treatment
Permanent or long term treatment depends on the cause of urinary obstruction. This may involve surgery either using large incisions or using the robotic technology for precision and more effectiveness. The benefits of minimally invasive procedure means faster recovery, less pain and minimal scarring. If the kidney function has deteriorated, then one may need additional treatments including dialysis. Dialysis may be either temporary or permanent.
If the urinary obstruction has caused an infection, antibiotics will be used to clear the process. In most cases, satisfactory management is availabel for most cases of urinary obstruction if the treatment is obtained early.