26th June 2023

Management of Acute Obstruction

Early diagnosis is important because most cases of obstruction can be corrected and a delay in treatment can lead to irreversible kidney damage. Doctors may suspect obstruction based on a patient’s symptoms, such as renal colic, symptoms of bladder distention, or a decrease in the volume of urine. A distended bladder can sometimes be felt in the lower part of the abdomen just above the pubic bone.

The first step in the management of acute obstruction is with urethral catheterisation.
Urethral catheterisation (insertion of a hollow, soft tube through the urethra) is often the first diagnostic test done in people with symptoms that suggest the bladder is distended, such as pelvic pressure or distention. If the catheter drains a large amount of urine from the bladder, this suggests that either the bladder outlet or the urethra is obstructed.

The next step is to investigate the cause of the obstruction with investigations which may include renal tract ultrasound, CT KUB or micturition studies.

The cause of the obstruction is targeted. If the cause of obstruction cannot be rapidly corrected or relieved by urethral catheterisation, particularly if there is infection, kidney failure, or severe pain, the urinary tract is drained via nephrostomy or suprapubic catheter, depending on the level of obstruction.