Home About us Current issue Ahead of Print Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 1984 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

RENAL DATA FROM THE ASIA - AFRICA Table of Contents   
Year : 2006  |  Volume : 17  |  Issue : 3  |  Page : 415-419
Obstructive Uropathy in Sudanese Patients


1 Department of Surgery, Gezira Hospital, Medani, Sudan
2 Department of Pediatric Surgery, Gezira Hospital, Medani, Sudan
3 Department of Renal Diseases, Gezira Hospital, Medani, Sudan
4 Wad Medani Obstetric Hospital, Medani, Sudan

Click here for correspondence address and email
 

   Abstract 

In this paper we describe the causes, patterns of presentation, and management of obstructive uropathy in Sudanese patients in a retrospective multi-center audit. All patients who presented with obstructive uropathy during 2005 were included in this study. All of the patients were subjected to serial investigations including imaging and tests of renal function. Diversion, stenting, and/or definitive surgery were performed in order to relieve the obstruction. Five hundred twenty patients were diagnosed with obstructive uropathy during this period; 345 (66%) patients presented with chronic obstruction and 175 (34%) with acute obstruction. Of the study patients, 210 (40%) presented with significant renal impairment; 50 (23%) of them required emergent dialysis. The patterns of clinical presentation of the obstructed patients included pain at the site of obstruction in 48%, lower urinary tract symptoms in 42%, urine retention in 36.5%, mass effect in 22%, and anuria in 4%. Patients in the pediatric age group constituted 4% of the total. The common causative factors of obstruction included congenital urethral valves, pelvi-ureteral junction obstruction, urolithiasis, and iatrogenic trauma, especially in the obstetric practice. Renal function was completely recovered with early management in 100% of patients with acute obstruction and was stabilized in 90% of patients with chronic obstruction. Four patients were diagnosed with end-stage renal failure; two of them were transplanted. The mortality rate in this study was less than 0.3%.

Keywords: Urinary, Obstruction, Renal, Acute, Chronic, Dialysis, Transplantation.

How to cite this article:
El Imam M, Omran M, Nugud F, Elsabiq M, Saad K, TAHA O. Obstructive Uropathy in Sudanese Patients. Saudi J Kidney Dis Transpl 2006;17:415-9

How to cite this URL:
El Imam M, Omran M, Nugud F, Elsabiq M, Saad K, TAHA O. Obstructive Uropathy in Sudanese Patients. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2021 Mar 6];17:415-9. Available from: https://www.sjkdt.org/text.asp?2006/17/3/415/35778

   Introduction Top


Obstructive uropathy may be acute or chronic, complete or incomplete, and unilateral or bilateral. It has diverse causes that produce similar disturbances in renal function and urine flow. [1]

Urinary tract obstruction is relatively common and has potentially serious clinical consequences. The autopsy-based studies estimate the incidence of obstruction as 3% in adults and 2% in children.[2]

Animal models of unilateral obstruction estimate the degree of recovery of renal function to be inversely proportional to the duration of ligation up to 40 days.[3],[4] After that, recovery of renal function is unlikely, though some case reports describe recovery of renal function in humans following presumed obstruction for 28-150 days.[5] Furthermore, the location of the obstruction has an impact on the prognosis, e.g. the recovery of renal function after adequate kidney drainage was slower in cases of intravesical obstruction in comparison to cases of ureteric obstruction.[6]

The incidence and causes of urinary tract obstruction vary with the age of the patient. Obstructive uropathy is the cause of renal failure in 16.2% of children who undergo renal transplantation, 12.9% who are main­tained on dialysis, and 23.1% who have chronic renal insufficiency. [7] Uretero-pelvic junction obstruction accounts for the majority of cases in children, while calculi are more common in young adults. On the other hand, benign prostatic hyperplasia or carcinoma, retroperitoneal or pelvic neoplasm, and calculi are the primary causes in older patients.[8]

In this study, we attempt to determine the causes, patterns of presentation, and the most effective management of obstructive uropathy in Sudanese patients.


   Patients and Methods Top


This is a retrospective cross-sectional multi­center study conducted at the Gezira Hospital for Renal Diseases and Surgery, the Gezira National Center for Pediatric Surgery, and the Medani Maternal Hospital.

All age groups were included. All patients with a confirmed diagnosis of obstructive uropathy were included. All patients were admitted to the hospital. Full history and physical examination were performed in addition to investigations that included serial assessment of renal function. Emergent inter­vention in the case of documented obstruction included ultrasound (US) or fluoroscopic guided nephrostomy with double J catheter insertions, urethral catheters, or suprapubic catheters. Definitive interventions such as transurethral resection of the prostate (TURP), trans-vesical prostatectomy (TVP), and visual internal urethrotomy (VIU) were performed following extensive investigations. We restricted the use of aminoglycosides and adjusted the doses according to the level of renal function. Furthermore, we used nonionic contrast media cautiously in the imaging of the urinary tract.


   Results Top


Five hundred twenty patients were diagnosed with obstructive uropathy during the study period; 345 (66%) patients presented with chronic obstruction and 175 (34%) with acute obstruction. Of the study patients, 210 (40%) presented with significant renal impair­ment, and 50 (23%) of them required emergent dialysis. The patterns of clinical presentation of the obstructed patients included pain at the site of obstruction in 48%, lower urinary tract symptoms in 42%, urine retention in 36.5%, mass effect in 22%, and anuria in 4% see [Table - 1]. The common causative factors of obstruction included congenital urethral valves, pelvi­ureteral junction obstruction, urolithiasis, and iatrogenic trauma, especially in the obstetric practice, [Table - 2]. The causes of obstructive uropathy in the pediatric age group are shown in [Table - 3]. For the 30 (4%) children in our study, meatal stenosis and neurogenic bladder were the most common causes of obstructive uropathy.

Renal function was completely recovered with early management in 100% of patients with acute obstruction and was stabilized in 90% of patients chronic obstruction [Table - 4].

Two patients were transplanted, and the other six patients were maintained on regular dialysis.


   Discussion Top


The term obstructive uropathy, although it should be reserved for the damage to the renal parenchyma that ultimately results from an obstruction to the urine anywhere along the urinary tract, could also refer to the mechanical or functional changes in the urinary tract that interfere with normal urinary flow. [9] Ureteral obstruction with subsequent hydronephrosis is a common clinical occurrence. The incidence of hydronephrosis was found to be 3.1% among 59,664 patients ranging in age from birth to 80 years. [10]

The complexes of symptoms are variable according to the time interval over which the obstruction occurs (i.e. acute or chronic), the lateralization of obstruction (unilateral or bilateral), and the severity of obstruction (partial or complete). We found a large degree of variability in our cohort.

Diagnosis is usually established through history, clinical examination, and investi­gations. Ultrasonography is used initially for the evaluation of obstructive uropathy in our study; it is a safe, non-invasive tool for the diagnosis of obstructive uropathy. Other imaging techniques, such as intravenous urogram (IVU) and radioisotope scans, are used as complementary tools for diagnosis. [11] Our algorithm for investigations was uniform in all the patients.

Benign prostatic hyperplasia (BPH) was the largest single cause of urinary obstruction in one series; BPH accounted for more than 30% of cases. [12] The second most common cause of obstructive uropathy was urinary stone disease at a different site in the urinary tract. Another cause worth mentioning was trauma, especially to gynecologic ureters in 3% of patients; bilateral ligation of ureters was found not uncommonly in caesarean sections. Moreover, cancer of the bladder, kidney, and prostate accounted for the cause of 8% of the cases of obstructive uropathy in our patients. Cervical cancer was the cause in two of our patients. Due to the anatomic proximity of the cervix to the bladder neck, obstruction can complicate 30% of cervical cancers.[13]

Management of obstructive uropathy begins with the identification of the obstructive process. Furthermore, the most important aspect of treating patients with obstructive uropathy is to expeditiously relieve the obstruction.[14] We approached our patients who presented with acute obstruction with an aggressive strategy to reestablish the urine flow.

We diverted urine flow by a nephrostomy tube in many cases. The advantages of per­cutaneous nephrostomy include rapid and safe drainage, facilitated use of an antegrade contrast study, and specific determination of status of the functional capacity of the obstructed kidney.[15]

At present, extracorporeal lithotripsy and percutaneous nephrolithotomy are being used more often in our patients for the treat­ment of stones than open surgical techniques.

Our patients who presented with acute obstruction recovered completely, while those with chronic obstruction had worse outcomes, which included the requirement of renal replacement therapy.

We conclude that obstructive uropathy is common among Sudanese patients presenting with significant impaired renal function. Urinary stones and BPH are the common causes of urinary obstruction. Active surgical intervention and creation of adequate urine outflow from the obstructed kidney is the method of choice for initial treatment, even in cases of chronic obstruction.

 
   References Top

1.O'reilly PH. Obstructive uropathy. QJ Nucl Med 2002;46(4):295-303.  Back to cited text no. 1    
2.Curhan GC, Zeidel ML. Urinary tract obstruction: In: Brenner BM. The kidney. 5 th ed. Philadelphia: WB Saunders: 1996: 1936-58.  Back to cited text no. 2    
3.Kerr WS. Effect of complete ureteral obstruction in dogs on kidney function. Am J Physiol 1956:521-586.  Back to cited text no. 3    
4.Widen T. Restitution of kidney function after induced urinary stasis of varying duration. Acta Chir Scand 1957;113:507-10.  Back to cited text no. 4    
5.Shapiro SR, Bennett AH. Recovery of renal function after prolonged unilateral ureteral obstruction. J Urol 1976;115:136-40.  Back to cited text no. 5    
6.Ramonas H, Zelvys A. Treatment of patients with urinary tract obstruction and significant renal impairment. Medicina (Kaunas) 2002;38 Suppl 1: 30-5  Back to cited text no. 6    
7.Hinds AC. Obstructive uropathy: consideration for the Nephrology nurse. Nephrol Nurs J 2004;31(2):166-74.  Back to cited text no. 7    
8.Bierer S, Ozgun M. Bode ME, Wulfing C, Piechota HJ. Obstructive uropathy in adults. Aktuelle Urol 2005;36(4):329-36.  Back to cited text no. 8    
9.Ishidoya S, Kaneto H, Fukuzaki A, et al. Pathophysiology and clinical implications of obstructive nephropathy. Nippon Hinyokika Gakkai Zasshi 2003;94(7):645-55.  Back to cited text no. 9    
10.Frederick A. Pathophysiology of Urinary tract obstruction in Walsh, Petik, Campbell's urology. 7 th edition W.B. Saunders vol. 1, Philadelphia 343-386  Back to cited text no. 10    
11.Talner LB. Specific causes of obstruction in Pollack HM ed. Clinical urography, vol. 2. Philadelphia W.B. Saunders company 1990 p. 1629.  Back to cited text no. 11    
12.Jacobsen SJ, Girman CJ, Guess HA, et al. New diagnostic guidelines for BPH, potential impact in the USA. Arch Intern Med 1996;80:83-98.  Back to cited text no. 12    
13.Lau MW, Temperley DE, Mehta S, et al Urinary tract obstruction and nephrostomy drainage in pelvic malignant disease. Br J Urol 1995;76:565-9.  Back to cited text no. 13    
14.Patrick A. Obstructive nephropathy, Patho­physiology, diagnosis, and collaborative management. Nephrol Nurs J 2002;29:15-20.  Back to cited text no. 14    
15.Teplick SK, Kaplan JM, Mandell GA, Richardson PA, Khanna OP. Percutaneous nephrostomy in a child with obstructive uropathy. Postgrad Med 1982;71(1):217-9.  Back to cited text no. 15    

Top
Correspondence Address:
M El Imam
Department of Surgery, Gezira university, P.O. Box 20, Medani
Sudan
Login to access the Email id


PMID: 16970266

Rights and Permissions



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4]



 

Top
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
    Introduction
    Patients and Methods
    Results
    Discussion
    References
    Article Tables
 

 Article Access Statistics
    Viewed5587    
    Printed84    
    Emailed0    
    PDF Downloaded611    
    Comments [Add]    

Recommend this journal