Male Urethral Obstructive Uropathy: Symptoms and Treatment

What Is Male Urethral Obstructive Uropathy?

Any hindrance in the urinary flow occurring due to various causes is known as male urethral obstructive uropathy. This is a prevalent and potentially serious condition affecting men of all ages. Obstructive uropathy is a urinary tract disease that can be structural or functional and is caused by obstructed urine flow. This urinary flow obstruction causes urine to back up or collect in the kidneys, damaging one or both kidneys. In addition, depending on where the obstruction is, the backflow of urine into the kidneys results in hydronephrosis (swelling of the kidney due to urine build-up). Male urethral obstructive uropathy can be acute (occurring suddenly) or chronic (long-term illness), but it is possible to treat this condition. However, if left untreated, symptoms like pain, fever, and infection can swiftly progress to severe ones like kidney failure, sepsis (it is a life-threatening problem due to infections), and even death.

What Causes Male Urethral Obstructive Uropathy?

Some of the common causes of male urethral obstructive uropathy include:

• Benign prostatic hypertrophy or hyperplasia is the most frequently diagnosed cause of male urethral obstructive uropathy. It is a condition characterized by enlargement of the prostate gland.

• Urinary bladder stones.

• Kidney stones.

• Urethral strictures (it is scarring of the urethra, a tube that takes urine out of the body).

• Constipation.

• Prostate cancer.

• Bladder or urethral cancer.

• Colon cancer.

• Issues with the bladder's supply nerves.

• Phimosis (a condition where the foreskin is too tight to be drawn back over the penis).

• Paraphimosis (males who have not undergone circumcision frequently have this common urologic emergency when their foreskin gets caught behind the corona of the penis glans).

• Retroperitoneal adenopathy (enlargement of retroperitoneal lymph nodes).

• Ureterocele (swelling at the bottom of ureters).

• Neuropathy bladder dysfunction (it is the dysfunction of the nerves that work between the bladder and the brain).

• Retroperitoneal fibrosis occurs when fibrous tissue develops in the region behind the abdomen. Cancer tumors or the use of some migraine medications may cause the fibers to develop. Urine backs up into the kidneys due to the fibers' encirclement and obstruction of the ureters.

• Chronic enlargement of the ureter wall which can be typically caused by conditions like schistosomiasis (it is an infectious disease caused by parasitic worms) or tuberculosis (a severe bacterial infection affecting the lungs).

Is Male Urethral Obstructive Uropathy a Common Condition?

• Although male urethral obstructive uropathy affects people of all ages, most cases occur in young children and the elderly.

• An estimated 4 % of all occurrences of urethral obstructive uropathy are thought to be caused by congenital genitourinary tract abnormalities.

• Male urethral obstructive uropathy symptoms occur in about 1 % to 2 % of men with benign prostate hyperplasia every year.

What Are the Symptoms of Male Urethral Obstructive Uropathy?

The nature of the symptoms depends greatly on whether the condition is acute or chronic and if one or both the kidneys are involved. However, the common symptoms of male urethral obstructive uropathy include:

• Mild to severe pain on the sides. It may be felt on one or both sides.

• Fever.

• Nausea and vomiting.

• Unusual weight gain.

• Swelling or edema of the kidneys.

• Increased urge to pee.

• Decreased force in urine stream.

• Difficulty in peeing.

• Urine dribbling.

• Feeling that the bladder is not emptied after urinating.

• Frequent peeing at night.

• Decreased amount of urine while peeing.

• Urine incontinence (leakage).

• Blood may be seen in the urine.

How Is Male Urethral Obstructive Uropathy Diagnosed?

Male urethral obstructive uropathy can be diagnosed in the following ways:

• Ultrasonography: Ultrasound of the pelvic or abdominal region may be advised to check for any pathologies in the pelvic and abdominal regions. The medical professional can see the kidneys and ureters during a retroperitoneal ultrasound, which is an ultrasound of the region behind the abdominal organs.

• CT (Computed Tomography) Scan: In a CT scan, cross-sectional images of the kidneys, ureters, and bladder are produced by combining a number of X-ray scans acquired from various angles with computer processing.

• Magnetic Resonance Imaging (MRI): An abdomen MRI produces precise images of the organs and tissues that make up the urinary system using a magnetic field and radio waves.

• Renal Nuclear Scan: During a renal nuclear scan, the doctor injects a tracer that contains a certain amount of radioactive material into the arm of the patient. Images from the radioactivity are produced by a specialized camera, which is then used to assess the urinary system.

• Cystoscopy: The urethra or a minor incision is used to insert a tiny tube with a camera and light. The optical system then lets the medical professional see inside the bladder and urethra.

• Blood and Urine Tests: Samples of urine and blood may be collected to investigate the presence of any kind of infection. The creatinine levels are also evaluated because these are markers for kidney dysfunction.

How Is Male Urethral Obstructive Uropathy Treated?

Treatment for male urethral obstructive uropathy aims to bypass or, if possible, remove obstructions to restore kidney damage. In addition, certain medications like antibiotics may help treat infections (if present). In addition, medications may also be given to treat enlarged prostate glands.

Drainage: A ureteral obstruction leading to severe pain may necessitate immediate drainage to remove urine from the body and temporarily alleviate the symptoms occurring due to the blockage. The drainage may be done in the following ways:

• A ureteral stent may be used to keep the ureter open.

• During a percutaneous nephrostomy, the doctor inserts a catheter through the back to directly drain the kidney.

• The bladder is connected to an external drainage bag using a catheter, a tube that is placed through the urethra.

Surgical Procedure: Surgery can be used to treat urethral obstruction in several ways. The situation and severity of the obstruction determine the type of procedure. One of these surgical techniques may be used for urethral obstruction treatment:

• Endoscopic Surgery: A lighted scope is inserted via the urethra into the bladder and other urinary tract areas during this procedure. The surgeon widens the damaged or blocked portion of the ureter by making an incision, and a stent is inserted to keep the ureter open.

• Open Surgery: To remove the obstruction and repair the ureter, the surgeon makes an incision in the abdomen during this procedure.

• Laparoscopic Surgery: In this method, the doctor makes one or more tiny incisions in the skin to introduce a tiny tube containing the necessary devices for the treatment, including a light, a camera, and other small instruments.

The duration of recovery following surgery and the number and size of incisions made during the treatment are the key differences between various surgical procedures. Therefore, the urologist chooses the optimal surgical strategy and type of surgery to treat the condition.

Conclusion:

The underlying cause of male urethral obstructive uropathy affects the prognosis. Acute urologic obstructions have a higher chance of reversion and cause less harm to other organs or the kidney filtration system. Whereas the long-term impacts on renal function are severe with chronic blockage. If the initial obstructive process just affects one kidney, the likelihood of developing chronic renal issues is reduced. Although rare, a kidney transplant or hemodialysis (it is a blood purification process done in a person, whose kidney does not function properly) be required in the long run if renal failure continues or worsens following an acute blockage. If recurrent urinary tract infections are left untreated, the prognosis as a whole gets worse.