urethral obstruction

Symptoms of Urethral Obstruction

Urethral obstruction can manifest in various ways, depending on the severity and location of the blockage. Some common signs and symptoms include:

• Abdominal pain: Pain in the abdominal area, which may be severe or mild, is a common symptom of urethral obstruction.
• Urinary retention: Inability to pass urine or weak stream of urine can indicate a blockage in the urethra.
• Blood in the urine: Presence of blood in the urine can be a sign of urethral obstruction, especially if it's accompanied by pain or difficulty urinating.
• Painful urination: Pain or discomfort while urinating is another symptom that may indicate a urethral obstruction.
• Urinary incontinence: In some cases, urethral obstruction can lead to urinary incontinence, where urine leaks uncontrollably.

Other Possible Symptoms

Less common symptoms of urethral obstruction include:

• Decreased urine flow: A decrease or interruption in the normal flow of urine can be a sign of a blockage.
• Flank pain: Pain in the flank area (side) or back can also indicate a urethral obstruction.

Seek Medical Attention

If you experience any of these symptoms, especially severe pain or blood in your urine, it's crucial to seek medical attention promptly. Ignoring these signs could lead to complications and further damage to your kidneys and urinary tract.

References:

• [3] Severe pain is a common symptom of ureteral obstruction due to kidney stones obstructing a ureter.
• [5] Symptoms of a ureteral obstruction include abdominal pain on one or both sides, which can also be relevant to urethral obstruction.
• [6] Signs and symptoms of urinary obstruction include inability to pass urine (urinary retention), weak stream of urine, blood in the urine, pain in either flank (side) or in the back, abdominal pain and/or swelling.
• [12] Urethral obstruction can cause various symptoms, including painful urination, urinary retention, and urinary incontinence.

To diagnose urethral obstruction, several tests can be used to help identify the cause and location of the blockage.

Imaging Studies

• Ultrasonography of the kidneys and bladder is a useful imaging modality as an initial study [3]. It is noninvasive and inexpensive and does not involve radiation.
• Imaging test with X-rays called a retrograde urethrogram (RUG) can also be used to visualize the urethra and identify any narrowing or blockage [7].
• Other imaging studies such as CT scan, MRI, and intravenous pyelogram (IVP) may also be used to diagnose ureteral obstruction, which is related to urethral obstruction [9].

Diagnostic Tests

• Urine tests can help detect infection, blood, or cancer in the urine [2].
• Urinary flow test can measure the rate of urine flow and help identify any blockages in the urethra.
• Blood tests may also be used to check for any underlying medical conditions that could be contributing to the obstruction.

Other Tests

• Voiding cystourethrogram (VCUG) is a test that uses X-rays to visualize the bladder and urethra during urination [9].
• Ultrasound of the kidneys, abdomen, or pelvis may also be used to diagnose ureteral obstruction [9].

It's worth noting that the specific tests used to diagnose urethral obstruction can vary depending on the individual case and the symptoms presented. A healthcare professional will typically use a combination of these tests to determine the cause and location of the blockage.

References: [2] - To test for a urethral stricture, we might perform a physical exam or one of these diagnostic tests: Imaging test with X-rays called a retrograde urethrogram (RUG) [7]. [3] - Ultrasonography of the kidneys and bladder is a useful imaging modality as an initial study. It is noninvasive and inexpensive and does not involve radiation. [7] - To test for a urethral stricture, we might perform a physical exam or one of these diagnostic tests: Imaging test with X-rays called a retrograde urethrogram (RUG) [7]. [9] - If your provider suspects you have an obstructed ureter, some of these tests and scans might be used to reach a diagnosis: Blood and urine tests. ... Yu ASL, et al., eds. Urinary tract obstruction. In: Brenner & Rector's The Kidney. 11th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Oct. 9, 2021.

Treatment Options for Urethral Obstruction

Urethral obstruction can be caused by various factors, including enlarged prostate, scarring from injury or surgery, and strictures. The goal of treatment is to remove blockages, if possible, or bypass the blockage to repair damage to the kidneys.

• Medications: Alpha-blockers, such as tamsulosin, can help relieve bladder obstruction by decreasing tonic contraction of prostatic smooth muscle [2]. 5-alpha reductase inhibitors, like finasteride, can also be prescribed to stop the growth of or shrink the prostate, improving urine flow [3].
• Optilume Technology: This technology combines mechanical dilation for immediate symptomatic relief with local drug delivery to maintain urethral patency [4].
• Surgery: In some cases, surgery may be necessary to repair or remove blockages. This can include procedures like balloon dilation or urethroplasty.

Current Research and Developments

Recent studies have explored new treatments for urethral obstruction. For example, a technology that aims to provide immediate symptomatic relief by widening the urethral lumen using balloon dilation, while maintaining long-term patency [6]. Additionally, research has shown that triamcinolone can inhibit scar fibroblast proliferation and enhance collagen degradation in the urethra [7].

Limitations and Future Directions

Unfortunately, there are no available drugs to help treat strictures. Without treatment, individuals will continue to experience problems with voiding. Further research is needed to develop effective treatments for this condition.

References:

[1] Clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis. [2] Alpha-blockers relieve bladder obstruction from BPH by decreasing tonic contraction of prostatic smooth muscle. [3] Medicines · 5-alpha reductase inhibitors help to stop the growth of or shrink the prostate, which can improve the flow of urine. [4] The Optilume technology combines mechanical dilation for immediate symptomatic relief with local drug delivery to maintain urethral patency. [6] This technology aims to provide immediate symptomatic relief by widening the urethral lumen using balloon dilation, while maintaining long-term patency. [7] Current evidence suggests that triamcinolone (TA) can inhibit scar fibroblast proliferation and enhance collagen degradation in the urethra.

Differential Diagnoses of Urethral Obstruction

Urethral obstruction can be caused by a variety of factors, and it's essential to consider the following differential diagnoses:

• Anterior urethral valves: These are abnormal folds of tissue that can block the flow of urine in the anterior (front) part of the urethra [3].
• Posterior urethral valves: This is the most common cause of urinary tract obstruction and chronic kidney disease resulting from obstructive uropathy in children. The valves are membranous folds situated within the posterior urethral lumen attached to the verumontanum [13].
• Urethral stricture: A narrowing or blockage of the urethra, which can be caused by injury, infection, or other factors.
• Severe phimosis: A condition where the foreskin is too tight and constricts the urethra.
• Bladder neck dyssynergia: A condition where there's an abnormal coordination between the bladder and urethra muscles.
• External sphincter dyssynergia: A condition where there's an abnormal contraction of the external urethral sphincter muscle.

These conditions can cause symptoms such as difficulty urinating, pain while urinating, or even complete urinary retention. It's crucial to consult a healthcare professional for proper diagnosis and treatment.

References:

[3] Decramer S, Buffin-Meyer B, Klein J, Fossum M, Wu HY. Fetal biomarkers for lower urinary tract obstruction secondary to posterior urethral valves. J Pediatr Urol. 2024 Jan 14.

[13] Posterior urethral valves are the most common cause of urinary tract obstruction and chronic kidney disease resulting from obstructive uropathy in the pediatric population.