Welcome to AccessAtlanta!

Obstructive uropathy occurs when the flow of urine is blocked causing the kidneys to dilate and become damaged. Obstruction can occur anywhere throughout the urinary system. If the obstruction is bilateral the most likely cause is bladder outlet obstruction. The kidneys produce urine in the normal manner but the urine cannot leave the bladder because of an obstruction. Urine may back up behind the obstruction and cause damage to the structures of the urinary tract.

When the obstruction is located so urine backs up into both kidneys, hydronephrosis (distention of the kidney pelvis and calyces) results. If both kidneys are affected, this can eventually lead to hypertension and/or renal failure. Sudden blockage causes acute bilateral obstructive uropathy, while slow progressive blockage causes chronic bilateral obstructive uropathy.

Chronic bilateral obstructive uropathy is caused by gradual obstruction of both ureters, the bladder, or urethra, resulting in a back-up of urine into both kidneys. In men, this is most often as a result of a benign enlargement of the prostate (BPH). Bladder outlet obstruction is much less common in women, but can be caused by a bladder cystocele.

Other causes include bladder tumors, prostate tumors, and tumors or masses (aggregations of cells) of the uterus or other structures around the bladder neck or urethra, including retroperitoneal fibrosis. Narrowing of the urethra may also cause obstruction secondary to a congenital deformity or scar tissue from injury or infection.

Initially, the bladder reacts to the obstruction by increased irritability. There is a stronger and more frequent urge to urinate, and bladder spasms or incontinence may occur. As urine accumulates, it may lead to stasis of urine and urinary tract infections. Symptoms are the result of urinary retention and damage to the bladder, ureters, and kidneys.

Chronic bilateral obstructive uropathy occurs in about 1 out of 1,000 people.