Acute bilateral obstructive uropathy is a sudden blockage of the flow of urine from both kidneys.

Obstructive uropathy occurs when the flow of urine is blocked. The kidneys continue to produce urine in the normal manner, but the urine does not drain properly because of the obstruction. This causes swelling of the kidneys (hydronephrosis). A sudden blockage that affects both kidneys causes acute bilateral obstructive uropathy. The condition may eventually lead to hypertension or acute renal failure.

In men, acute bilateral obstructive uropathy is most often a result of an enlarged prostate. Other causes in men include prostate cancer, bilateral obstructing kidney stones and bladder cancer. Acute bilateral obstructive uropathy is much less common in women, but may occur as a result of a bladder cystocele, pregnancy, injury from surgery involving the reproductive organs, or cervical cancer. Other causes include posterior urethral valves in infant boys, neurogenic bladder, papillary necrosis, coagulated blood, fungus and other rare retroperitoneal processes.

Acute bilateral obstructive uropathy occurs in about 5 out of 10,000 people.

• Decreased urine output (may be less than 10 mL per day)
• Urinary hesitancy
• Abnormal urine flow -- dribbling at the end of urination
• Incontinence
• Decrease in the force of the urinary stream, stream small and weak
• Increased urinary frequency or urgency
• Need to urinate at night
• Frequent strong urge to urinate
• Burning or stinging with urination
• Feeling of incomplete emptying of the bladder
• Sudden flank pain or pain on both sides
• Blood in the urine
• Fever
• Nausea and vomiting
• High blood pressure (hypertension), recent increase
• Urine, abnormal 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. Fever is common with an infection.

• Urinalysis and a urine culture (clean catch) may show a urinary tract infection.
• Serum creatinine may increase suddenly, by 2 mg/dL or more over a 2-week period.
• 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. Blood BUN may increase suddenly. Creatinine clearance may be decreased.
• A blood potassium test may be elevated.
• 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).
• Arterial blood gas and blood chemistries may show metabolic acidosis.

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

• IVP
• Renal scan
• Ultrasound of the kidneys
• Abdominal CT scan

• Radionuclide cystogram
• Creatinine - urine