Urinary Tract Obstruction


Lower Urinary Tract Obstruction

(i.e. obstruction of the urethra or bladder)

  • Etiology: Benign prostatic hypertrophy (BPH),meatal stricture (i.e. scar tissue of the outer tip of the urethral causing blockage to urination), urethral stricture (i.e. scar tissue in the urethra causing blockage to urination), bladder neck contracture (i.e. scar tissue at the level of the bladder neck causing blockage to urination), foreign body or stone in the bladder or urethra , urethral diverticulum, non-urologic malignancy causing compression and obstruction of the lower urinary tract, vs other etiology
  • Evaluation
    • Lab tests: PSA in men, electrolytes, and kidney function
    • Urine tests: urinalysis, urine culture and sensitivity, possible urine cytology if concern for a malignant etiology
    • Imaging: Depending on concern for different etiologies (plain film, cystogram, urethrogram, voiding cystourethrogram, ultrasound, CT scan, MRI, or other)
    • Possible cystoscopic exam (i.e. scoping of the lower urinary tract)
    • Possible urodynamic evaluation (i.e. evaluation of the storage and emptying characteristics of the bladder and urethra
  • Management
    • Benign prostatic hypertrophy (BPH): see separate section
    • Prostate cancer: see separate section
    • Urethral cancer: see separate section
    • Meatal/urethral stricture or bladder neck contracture: Typically requires dilation of the scar tissue, incision of the scar tissue using special scopes with cutting or laser devices, or surgical reconstruction depending on the length and thickness of the scar tissue.
    • Stone or foreign body in the bladder or urethra: Typically requires surgical removal using scopes, but at times requires surgical management via incisions.
    • Urethral diverticulum: Typically requires surgical removal of the diverticulum and urethral reconstruction.
    • Non-urologic malignancy causing compression and obstruction of the lower urinary tract—treatment of the primary malignancy, decompression of urine and pressure from the lower urinary tract using transurethral catheters, suprapubic catheters (i.e. traversing the abdominal wall into the bladder), or even percutaneous nephrostomy tubes (i.e. tube going through the back into the kidney to drain urine from the kidney and relieve kidney pressure), possible surgical reconstruction if non-urologic malignancy can be effectively controlled.


Upper Urinary Tract Obstruction

(i.e. obstruction of the ureters and kidneys)

  • Etiology: Ureteral or renal pelvis stricture (i.e. scar tissue involving the ureter or renal pelvis of the kidney), a blood vessel crossing the ureter or renal pelvis causing compression and blockage of the urinary tract, poor urinary drainage of the kidney due to high insertion of the ureter into the renal pelvis or ureteral valves, adynamic ureteral segment (i.e. a portion of the ureter which does not have normal peristalsis), ureterocele, ureteral or kidney stone, foreign body in the ureter or kidney, ureteral or renal pelvis tumor, kidney tumor, non-urologic malignancy (i.e. non-urinary tract cancer) causing compression of the ureter, vs other etiology.
  • Evaluation
    • Labs to evaluate electrolytes and kidney function
    • Urine tests: urinalysis, urine culture and sensitivity, possible urine cytology if concern for a malignant etiology
    • Imaging: Depending on concern for different etiologies (plain film, IVP, nuclear kidney scans, ultrasound, CT scan, MRI, or other)
  • Management
    • Ureteral or renal pelvis obstruction from stricture, crossing vessel, high ureteral insertion into the renal pelvis, ureteral valves, adynamic ureteral segment– Dilation, endopyelotomy, surgical reconstruction (i.e. surgical reimplanation, uretero-ureterostomy, pyeloplasty), depending on etiology.
    • Ureterocele—endoscopic incision, surgical reconstruction
    • Ureteral or kidney stone—see separate section
    • Foreign body in the ureter or kidney—endoscopic removal or surgical, incisional removal with reconstruction
    • Ureteral or renal pelvis tumor—see separate section
    • Non-urologic malignancy (i.e. non-urinary tract cancer) causing compression of the ureter—treatment of the primary malignancy, decompression of the urinary tract with ureteral stent (i.e. internal tube that traverses the ureter from the bladder to the kidney to drain urine and relieve kidney pressure) or percutaneous nephrostomy tube (i.e. tube going through the back into the kidney to drain urine from the kidney and relieve kidney pressure), possible surgical reconstruction if non-urologic malignancy can be effectively controlled.