Urinary Tract Obstruction Clinical Presentation

Updated: Jan 03, 2020
  • Author: Edward David Kim, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Presentation

History

The clinical presentation of urinary tract obstruction varies with the location, duration, and degree of obstruction. Thus, a thorough history and physical examination are key in the patient evaluation.

Upper urinary tract obstruction (kidney, ureter) can manifest as pain in the flank, ipsilateral back, and ipsilateral groin. Nausea and vomiting are also common and usually occur in acute obstruction. Chronic obstruction is usually indolent and may be asymptomatic. When infection is present, the patient may have fever, chills, and dysuria. Hematuria may also be present.

When bilateral obstruction or unilateral obstruction in a solitary kidney is severe and renal failure has occurred, uremia can be present. Uremia symptoms include weakness, peripheral edema, mental status changes, and pallor. 

Lower urinary tract obstruction (bladder, urethra) can manifest as voiding dysfunction such as urgency, frequency, nocturia, incontinence, decreased stream, hesitancy, postvoid dribbling, and a sensation of inadequate emptying. Suprapubic pain or a palpable bladder indicates urinary retention. Infection may be present, and patients may experience dysuria. Hematuria may be present with or without infection.

Patients with urethral stricture may report a history of trauma, instrumentation, or sexually transmitted diseases; lower urinary tract pain is common.  [7] They may also experience a split urinary stream.

 

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Physical Examination

If hydronephrosis is severe, the kidney may be palpable on physical examination, especially in children. However, obstructive nephropathy without hydronephrosis has been reported. [8] In cases that involve an infectious process, costovertebral angle tenderness can indicate pyelonephritis.

Digital rectal examination is indicated in men, as it can reveal prostatic enlargement, decreased rectal tone, or prostatitis. [9]  Urethral stricture often requires cytoscopy for diagnosis. Meatal stenosis is usually apparent on physical examination.  In women, uterine or bladder prolapse can be identified on a pelvic examination. A urethral diverticulum can also be palpated on pelvic examination.

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