What is the relationship between ileus and obstructive uropathy?

From the Guidelines

Ileus and obstructive uropathy require prompt medical attention, with management of ileus involving bowel rest, nasogastric tube decompression, intravenous fluids, and electrolyte correction, while obstructive uropathy treatment focuses on relieving the obstruction through placement of ureteral stents or nephrostomy tubes, depending on the location and cause of blockage, as recommended by the 2023 WSES guidelines 1.

Management of Ileus

• Bowel rest
• Nasogastric tube decompression
• Intravenous fluids
• Electrolyte correction
• Prokinetic agents like metoclopramide (10mg IV every 6 hours) or erythromycin (250mg IV every 6 hours) may help stimulate gut motility, as suggested by the postoperative pain management guidelines 1

Management of Obstructive Uropathy

• Relieving the obstruction through placement of ureteral stents or nephrostomy tubes, depending on the location and cause of blockage
• Antibiotics are necessary if infection is present, with options including ceftriaxone (1-2g IV daily) or piperacillin-tazobactam (3.375g IV every 6 hours)
• Monitoring of vital signs, fluid status, and laboratory values

Connection between Ileus and Obstructive Uropathy

• Shared risk factors like retroperitoneal processes, malignancies, or inflammatory conditions that can simultaneously affect both gastrointestinal and urinary systems
• Early intervention is crucial to prevent complications such as renal failure in obstructive uropathy or bowel ischemia in prolonged ileus, as highlighted by the 2023 WSES guidelines 1

Key Recommendations

• Prompt medical attention is essential for both ileus and obstructive uropathy, with a focus on relieving the obstruction and managing symptoms, as recommended by the 2023 WSES guidelines 1
• Ureteral stents or nephrostomy tubes should be placed to relieve the obstruction, depending on the location and cause of blockage, as suggested by the guidelines 1
• Prokinetic agents may help stimulate gut motility in ileus, as recommended by the postoperative pain management guidelines 1
• Antibiotics should be used if infection is present, with options including ceftriaxone (1-2g IV daily) or piperacillin-tazobactam (3.375g IV every 6 hours), as recommended by the guidelines 1

From the Research

Ileus and Obstructive Uropathy

• Ileus is not directly mentioned in the provided studies, however, obstructive uropathy is a condition where there is a blockage in the urinary tract, which can lead to various complications.
• The treatment of obstructive uropathy typically involves decompression of the urinary tract, which can be achieved through various methods, including percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS) 2, 3.
• A study comparing PCN and RUS found that both methods are effective for decompression of an obstructed urinary system, with no significant difference in most outcomes, although PCN is preferable due to its reduced impact on post-operative quality of life 3.
• Another study found that percutaneous CT-guided nephrostomy is a safe and quick alternative method for management of obstructive and nonobstructive uropathy, with a low complication rate 4.
• The prognosis of renal function changes due to obstructive uropathy and prediction of remaining renal function after release of obstruction have a great impact on treatment choices, and active surgical intervention is often the method of choice 5.
• A case report described a woman who presented with deteriorating renal function due to obstructive uropathy caused by a retained urethral catheter within an ileal conduit, which was successfully treated with a right nephrostomy and endoscopic removal of the catheter 6.