Therapy for obstructive uropathy is largely determined by whether the obstruction involves one or both kidneys, and by the age of the patient. In the infant and child, obstructive uropathy is almost always due to a congenital malformation of the ureter, bladder, or urethra. Ultrasonographic prenatal diagnosis has permitted early detection and even fetal intervention for posterior urethral valves, although this form of treatment must be considered experimental at present. More important to the affected infant than optimal renal development is the prevention of pulmonary hypoplasia, which is a consequence of fetal
oliguria and
oligohydramnios. Congenital ureteropelvic junction (UPJ) obstruction is generally unilateral, and although there is controversy regarding the timing of surgical correction, current evidence favors early pyeloplasty. In the adult, obstructive nephropathy is often acquired, with
ureteral obstruction usually a consequence of
nephrolithiasis. Removal of the stone can be accomplished surgically or by
lithotripsy.
Bladder outlet obstruction is usually secondary to
prostatic hyperplasia, which may progress slowly, allowing a delay in surgical intervention.
Neurogenic bladder may require intermittent catheterization or
cholinergic therapy; those with hypertonic bladder may benefit from
anticholinergics. Regardless of the patient's age, prompt and accurate diagnosis is essential to planning an optimal strategy for the management of obstructive uropathy.