The urinary tract (or urinary system) constitutes your kidneys, ureters, bladder, prostate and urethra, and allows the 1.5L of waste product per day, filtered by the kidneys, IE Urine to drain from the body.
What is urinary tract obstruction?
Urinary tract obstruction occurs because of a blockage that prevents urine from flowing through the urinary tract. This obstruction which can be at any level within the system, causes urine, a waste product to back up; generally within the bladder – urinary retention or kidneys and ureters; hydronephroureterosis.
The ureters are two tubes that carry urine from each of your kidneys to your bladder. Urinary tract obstruction can lead to swelling and damage to one or both of your kidneys. Blockages can be temporary or permanent and affect one side or both sides of the urinary tract; this could lead to urinary sepsis or renal failure if undiagnosed or untreated.
Urinary tract obstruction can develop quickly (acutely) or slowly (chronically).
What are the symptoms of urinary tract obstruction?
Symptoms of urinary tract obstruction depend upon the location and duration of the obstruction:
In the upper urinary tract they include:
- Pain
- Unbearable pain between the ribs and hips or lower abdomen
- Pain in the testicles
- Nausea and vomiting
- Fever/chills
- Blood / debris within urine
Signs of a blockage in your lower include:
- Difficulty passing urine (burning / stinging)
- A slowed stream or a dribble
- Frequent, sudden or urgent need to pass urine
- Feeling of incomplete emptying
- Incontinence
- Blood or debris within urine
- Feeling that your bladder is full
You may pass less urine if just one of your kidneys is blocked. Usually both kidneys need to be blocked to affect the amount of urine you pass.
What causes urinary tract obstruction?
As an enlarged prostate is the most common cause of lower urinary tract obstruction in men over 40, urinary tract obstruction is more common among men but does also occur in women.
Causes of urinary tract obstruction include:
- Stones in the kidney, ureter or bladder.
- Benign prostatic hyperplasia (BPH) or prostate cancer
- Tumour, lumps and cysts in the Kidneys, bladder, prostate or other pelvic organs
- High tone non-relaxing sphincter or Fowler’s Syndrome in Females
- Urethral Stricture (male and female)
- Ureteric strictures (narrowing caused by scar tissue) can develop after prior abdominal or pelvic surgery or radiotherapy
- Congenital Abnormalities
- Abnormal thickening of the bladder wall or the way it contracts
- Neuropathic Bladder in Spinal Injury
- Polyps in the ureter
- Blood clot in the ureter
- Tumours in or near the ureter
- Radiation therapy
- Medication
- Ureter bulging into the bladder
- Stool stuck in the rectum
- Gynaecological Prolapse
How is urinary tract obstruction diagnosed?
If you think you have symptoms of urinary tract obstruction, it is important you see your doctor as soon as possible. Delay in treatment can lead to irreversible kidney or bladder damage and prolongation of symptoms.
To make a diagnosis, your Urologist will ask about your symptoms as well as where you feel pain and examine you.
If further investigation is needed, you might also undergo an:
- Ultrasound, CT or MRI scan – an image shows if urine is backing up into your kidneys and can identify blockages
- Flow/Pressure Studies – Measures the effectiveness of bladder emptying and the pressures generate by the bladder to objectively quantify an obstruction index.
- Bladder catheterisation – a tube is inserted through the urethra to see if a large amount of urine drains from the bladder, which means there is an obstruction
- Endoscopy – an endoscope (a cystoscope) examines the urethra, prostate and bladder to identify obstruction and can sometimes remove the blockage. Can be done in outpatients under local anaesthetic.
- Blood and urine tests – measure renal function and check for evidence of infection.
How is urinary tract obstruction treated?
Treatment options vary individual by individual and the level and severity of obstruction as well as patient’s symptoms.
Treatment options include:
- Medication – to reduce bladder pressures or shrink/relax an obstructive prostate
- Catheterisation – to help empty the bladder, either with a permanently fitted tube or teaching self-catheterisations.
- Surgery – removes or reconstructs the obstruction: such as cancerous tumours, ureteric strictures, stones, scar tissue, enlarged prostate, dysfunctional bladder or sphincter so that urinary drainage is improved. Often the aim is to assist patients become tube free (IE catheter or stent)
If you’re unsure what treatment you should go for, or the above treatments don’t work for you, our team of expert urology specialists are here to help.
