Urinary Obstruction Follow-up

Updated: Feb 23, 2016
  • Author: Michael A Policastro, MD; Chief Editor: Erik D Schraga, MD  more...
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Follow-up

Further Outpatient Care

Depending on specific complications of obstruction, relief of bladder neck obstruction by urethral catheterization requires prompt (within 1 wk) follow-up care with a urologist for definitive therapy.

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Further Inpatient Care

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  • Decision to admit the patient depends on the need for invasive surgical drainage procedures and complications of obstruction.
  • Replacement of electrolyte disturbances should be treated accordingly.
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Transfer

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  • Patients with indications for acute hemodialysis may need to be transferred if a facility is not available at the presenting institution.
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Complications

Postobstructive diuresis is an uncommon but clinically significant complication following the release of urinary obstruction.

It is characterized by a marked natruresis and diuresis with excretion of large amounts of sodium and water.

In addition to the potential for severe volume depletion, electrolyte disorders such as hypokalemia, hyponatremia, hypernatremia, and hypomagnesemia may occur.

Etiology of this massive diuresis and electrolyte loss is multifactorial. It is related to fluid and urea overloads during obstruction and acquired tubular resistance to antidiuretic hormone and aldosterone.

Treatment of postobstructive diuresis consists of judicious fluid replacement with 0.45% saline (at a rate slightly less than urine output) and replacement of electrolytes.

Urinary tract infections may occur due to urinary stasis. Additionally, instrumentation may also introduce contamination. Antibiotic selection depends on the age, sex, and comorbid conditions of the patient. Additionally, minimizing drug interactions, such as patients on anticoagulation, should also guide antibiotic selection.

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Prognosis

The longer the duration of obstruction, the lower the probability of recovery of any renal function and the lower the resultant GFR.

In humans, partial recovery of function frequently is observed after less than 3 weeks of obstruction; however, case reports have noted some return of function after 5 months of obstruction.

UTIs complicating obstruction further decrease the probability of recovery.

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Patient Education

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