Chronic bilateral obstructive uropathy is the prolonged or progressive blockage of urine flow from both kidneys.

Obstructive uropathy occurs when the flow of urine from the kidneys is blocked (obstructed). This causes kidney swelling and damage. The blockage can occur anywhere along the urinary tract.

A slow blockage that gets worse over time causes chronic bilateral obstructive uropathy. Bilateral means the blockage affects both kidneys. The most common cause of this is bladder outlet blockage. In this condition, the kidneys produce urine in the normal manner but the urine cannot leave the bladder. Urine may back up behind this blockage and cause damage to the structures of the urinary tract.

When the blockage causes urine to back up into both kidneys, hydronephrosis (swelling of the kidneys) results. If both kidneys are affected, hypertension and renal failure may occur.

In men, the most common cause of chronic bilateral obstructive uropathy is due to the blockage of  of both ureters (the tubes between the kidneys and the bladder), the bladder, or the urethra. In men, this is most often as a result of a benign enlargement of the prostate (BPH). Such blockage is much less common in women.

Other causes of chronic bilateral obstructive uropathy include:

• Bladder tumors
• Prostate tumors
• Tumors or masses of the uterus or other structures around the bladder neck or urethra
• Retroperitoneal fibrosis  
• Narrowing of the urethra due to a birth defect or scar tissue

Chronic bilateral obstructive uropathy occurs in about 1 out of every 1,000 people.

See also: acute bilateral obstructive uropathy

Symptoms depend on the time course of the obstruction and where in the urinary tract the obstruction occurs.

Some of the most common symptoms of chronic obstructive uropathy include:

• Stronger and more frequent urge to urinate
• Difficulty initiating the flow of urine (urinary hesitancy)
• Dribbling of urine, incontinence
• Decreased urine output
• Decrease in the force of the urinary stream
• Increased need to urinate at night
• Burning or stinging with urination
• Feeling of incomplete emptying of the bladder
• Alternating times of increased urine output and decreased urine output
• Fever and chills (if there is also urinary infection)

• Nail problems
• High blood pressure
• Abnormal urine color

A physical exam may show swollen or tender kidneys. The bladder may be large and full. A rectal examination may reveal an enlarged prostate. Signs and symptoms of chronic renal failure may be present. Blood pressure may be high.

• A urinalysis and a urine culture (clean catch) may show a urinary tract infection.
• A CBC may show an increased white blood cell count  
• A basic metabolic panel will reveal patient's current kidney function as well as electrolyte balance, which may be abnormal.
• A bladder scan (ultrasound) may show a large amount of urine in the bladder after urinating (more than 50 mL).
• Uroflowmetry may reveal decreased urinary flow due to a swollen prostate (BPH).

The following tests may show hydronephrosis (swelling of kidneys):

• Abdominal ultrasound
• CT scan of abdomen and pelvis
• Renal scan