Complications
This may occur during catheterization if the catheter is forced when it meets resistance. This may create a false passage and hematuria. Suprapubic catheterization or cystoscopy may then be indicated.
This can be avoided by taking care not to force the catheter and seeking the advice of a urologist in difficult cases.
It is possible for stents to become dislodged or occluded, particularly if there is underlying malignancy.
If suspected, imaging is helpful and replacement ureteric stent or nephrostomy tube may be required.
May be seen in any patient, but most commonly after relief of bilateral obstruction or obstruction of a solitary kidney, especially after relief of urinary retention. Usually seen in patients with signs of fluid overload.
Occurs as a physiologic response to volume expansion and accumulation of solutes in the obstructed kidneys. Diuresis as much as 200 mL/hour may be seen. It typically resolves once homeostasis is achieved but may progress to a pathologic form.
Encourage oral rehydration and avoid intravenous fluids if patient is able to drink.
An obstructed and infected urinary system can result in severe sepsis and cardiovascular collapse if left untreated. Sepsis may also develop after the obstruction is relieved, especially in patients who have fevers and other signs of infection prior to decompression.
Untreated obstructive uropathy can lead to obstructive nephropathy. Unless obstruction is relieved, back pressure on the kidney can result in tubulo-interstitial fibrosis, tubular atrophy, and interstitial inflammation resulting in renal failure.
The risk of this is low if treated promptly. A community-based study looked at chronic kidney disease and found it to be associated with a post-voiding residual volume of >100 mL, moderate-to-severe lower urinary tract symptoms and decreased peak urinary flow rates, but found no association with prostatic enlargement.[16]
In a study of over 3000 men, none went on to develop renal insufficiency due to benign prostatic hyperplasia.[11]
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