Urinary obstruction

Nodular hyperplasia of the prostate is usually associated with a normal serum acid phosphatase activity. Complications such as acute urinary obstruction or prostatic infarction will elevate this serum activity for several days as will cystoscopy and catheterization (98). Digital palpation of the prostate may result in an elevation which subsides within a few hours. 

Decongestants such as OTC pseudoephedrine are sympathomimetic agents that constrict capacitance vessels in the nasal turbinates.17 Decongestants effectively reduce nasal congestion and to some extent rhinorrhea associated with AR.8,12 The recommended dose of pseudoephedrine is 30 to 60 mg every 4 to 6 hours for a maximum daily dose of 240 mg.15 Systemic adverse effects such as irritability, dizziness, headache, tremor, tachycardia, and insomnia can occur. Additionally, use is associated with increased blood pressure and intraocular pressure and urinary obstruction.8,12... 

Signs and symptoms Prepubertal children often present with stuttering priapism. Older males can present with prolonged episodes that last for days and should be managed as medical emergencies. Urinary obstruction can occur in severe cases. 

Under physiological conditions, values for ncc and PBC vary little. In other words, when plasma protein synthesis is normal and in the absence of any urinary obstruction that would cause urine to back up and increase PBC, the primary factor that affects glomerular filtration is PGC. An increase in PGC leads to an increase in GFR and a decrease in PGC leads to a decrease in GFR. 

Monitoring changes in UOP can help diagnose the cause of ARF. Acute anuria (less than 50 mL urine/day) is secondary to complete urinary obstruction or a catastrophic event (e.g., shock). Oliguria (400 to 500 mL urine/day) suggests prerenal azotemia. Nonoliguric renal failure (more... 

Urinary obstruction Drugs that increase cholinergic activity may cause urinary obstruction. 

Intestinal or urinary obstruction porphyria, hypersensitivity to sulfasalazine, its metabolites, salicylates, or sulfonamides. 

Sulfasalazine can precipitate attacks of porphyria and should not be used by individuals with bowel or urinary obstruction. 

Geriatric Considerations - Summary Alpha-adrenergic blockers are modestly effective alone, and in combination with 5-alpha reductase inhibitors (e,g, finasteride) in the treatment of urinary obstructive symptoms related to benign prostatic hyperplasia. Alfuzosin is a "uroselective" alpha-blockerwhich appears to cause less orthostatic hypotension than nonselective alpha-blockers such as terazosin, prazosin, and doxazosin. 

It is indicated in mild to moderate hypertension, symptomatic relief of urinary obstruction in patients of benign prostatic hypertrophy. 

Refluxing ureters can be treated endoscopically with sub-ureteric injection of polytetrafluoroethylene paste (Polytef), the STING procedure. However, ureteric obstruction has been described as a complication (8). Urinary incontinence has also been treated by periurethral or submucosal injections of Polytef, but reports of urinary obstruction (9,10) and poor long-term success (11,12) have limited the range of indications for this treatment. Other reported complications of Teflon injection for stress urinary incontinence include periurethral abscess, urethral diverticulum. Teflon granuloma with urethral wall prolapse (13), and microembolization (14). 

Boykin W, Rodriguez FR, Brizzolara JP, Thompson IM, Zeidman EJ. Complete urinary obstruction following periurethral polytetrafluoroethylene injection for urinary incontinence. J Urol 1989 141(5) 1199-200. 

The frequency and severity of the adverse effects of sulfonamides correspond to those seen with other antibacterial agents (2-5%). Dose-related effects, which tend to be more troublesome than serious, include gastrointestinal symptoms, headache, and drowsiness. Crystalluria can occur, but urinary obstruction is rare. Hematological adverse effects due to folic acid antagonism occur primarily in combination with trimethoprim. Hemolytic anemia occurs in patients with enzyme deficiencies and abnormal hemoglobins. Hypersensitivity... 

A 15-year-old girl, who had a history of recurrent urinary obstruction, formed a thick sludge of calcium oxalate in the bladder. 

Assess medical and drug history. Cholinergics can aggravate symptoms of peptic ulcer, urinary obstruction, or asthma. 

Hyperthyroidism, peptic ulcer, latent or active bronchial asthma, mechanical GI and urinary obstruction or recent GI resection, acute inflammatory GI tract conditions, anastomosis, bladder wall instability, pronounced bradycardia, hypotension, hypertension, cardiac disease, coronary artery disease, vasomotor instability, epilepsy, Parkinsonism. 

Selective Aldosterone Deficiency (Type IV RTA). In type IV RTA, there is failure of distal potassium and hydrogen ion secretion because of aldosterone deficiency or resistance. This may occur because of a range of steroid or steroid receptor synthetic defects or because of hyporeninemic hypoaldosteronism (e.g., due to diabetic nephropathy, tubulointerstitial disease, urinary obstruction, renal transplantation, or SLE). Hyperkalemia, although mild, is a usual manifestation. 

Hyperkalemic distal (type IV) RTA resulting from generalized distal tubule defects is less common than hyporeninemic hypoaldosteronism, but is more common than classic distal (type I) RTA. Patients with this defect have impaired tubular potassium secretion in addition to impaired urinary acidification (urine pH >5.5 despite acidemia or acid loading). Urinary obstruction is the most frequent cause of this disorder, which may also be associated with sickle-cell nephropathy, systemic lupus erythematosus, HIV nephropathy, analgesic abuse nephropathy, amyloidosis, renal transplant rejection, and chronic cyclosporine nephrotoxicity. 

Hellstrom P, Lukkarinen O, Kontturi M. Bladder neck incision or transurethral electroresection for the treatment of urinary obstruction caused by small prostate A randomized urodynamic study. Scand J Urol Nephrol 1986 20 187-192. 

The remaining 20% of recurrent UTIs are relapses, i.e., persistence of infection with the same organism after therapy for an isolated UTI. The recurrence of symptomatic or asymptomatic bac-teriuria after therapy usually indicates that the patient has renal involvement, a structural abnormality of the urinary tract, or chronic bacterial prostatitis. In the absence of structural abnormalities, relapse often is related to renal infection and requires a long duration of treatment. Women who relapse after short-course therapy should receive a 2-week course of therapy. In patients who relapse after 2 weeks of therapy, therapy should be continued for another 2 to 4 weeks. If relapse occurs after 6 weeks of therapy, urologic evaluation should be performed, and any obstructive lesion should be corrected. If this is not possible, therapy for 6 months or longer may be considered. Asymptomatic adults who have no evidence of urinary obstruction should not receive long-term therapy. 

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