Case history
Case history #1
A 68-year-old man presents to the emergency department complaining of an inability to urinate during the previous 12 hours. He has severe lower abdominal pain. Prior to this, he noted a weaker force of urinary stream, difficulty in starting his urinary stream, and frequent episodes of waking at night to pass urine. On examination, he has lower abdominal distention, which is dull to percussion.
Case history #2
A 32-year-old woman presents to the emergency department complaining of severe pain in her left flank. The pain started 6 hours before and varies in intensity, getting worse every 5 to 10 minutes. When the pain is at its worst, she is unable to get comfortable in any position. She is nauseous and has vomited twice. She is afebrile but has tenderness at the left costovertebral angle.
Other presentations
Unlike acute obstructive uropathy, chronic obstruction often presents with more insidious symptoms. A patient with a chronic unilateral obstruction may present with signs of pyelonephritis and chronic flank or lower abdominal pain. Unless there is disease involving the other kidney, creatinine is typically normal and the patient will still be passing normal amounts of urine. Patients with chronic bilateral obstruction (e.g., benign prostatic hyperplasia) or loss of bladder function (e.g., diabetes mellitus) may present with lower urinary tract symptoms such as urinary frequency, hesitancy, decreased force of stream, or overflow urinary incontinence. Occasionally patients are asymptomatic and may be diagnosed following incidental findings of chronic renal insufficiency or bladder enlargement when ultrasound examination or blood tests are performed for other reasons.
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