Are complications of urinary obstruction likely to include infection: true or false?

Complications of Urinary Obstruction Include Infection

Yes, infection is a significant complication of urinary obstruction. 1, 2

Pathophysiology of Infection in Urinary Obstruction

• Urinary obstruction leads to urinary stasis, creating an environment conducive to bacterial growth and subsequent infection 3
• Obstruction at any site in the urinary tract is a defining factor for complicated urinary tract infections (UTIs) 3
• Pyonephrosis (hydronephrosis with infection) is a severe complication of urinary obstruction that can be life-threatening 1

Clinical Manifestations

• Patients with urinary obstruction and infection commonly present with fever, flank pain, and leukocytosis 1
• Urinalysis is typically positive for blood and infection 1
• Patients may develop sepsis, which can be more severe in the presence of obstruction 2, 4

Diagnostic Considerations

• CT scans typically show dilated ureter and renal pelvis with perinephric stranding in cases of obstructive pyelonephritis 1
• Ultrasound may be more effective for diagnosing pyonephrosis specifically 5
• Urine culture and susceptibility testing should always be obtained before initiating treatment in complicated UTIs due to obstruction 3

Management Approaches

• Antibiotics alone are insufficient in treating acute obstructive pyelonephritis/pyonephrosis 1
• Urinary tract decompression is considered lifesaving in patients with pyonephrosis 1
• Options for decompression include:
  • Percutaneous nephrostomy (PCN) placement 1
  • Retrograde ureteral stenting 1
• The technical success rate for PCN placement approaches 100% when performed with image guidance 1

Outcomes and Complications

• In patients with pyonephrosis, patient survival was 92% when PCN was used, compared with 88% for open surgical decompression and 60% for medical therapy without decompression 1
• Hospital mortality in patients with septic shock due to UTI with obstruction was 27.3% compared to 11.2% in patients without obstruction 2
• Hospital length of stay among survivors was longer in patients with obstruction (12.8 days vs. 8.3 days) 2

Special Considerations

• Patients with urinary obstruction require longer antibiotic treatment duration (7-14 days) compared to uncomplicated UTIs 3
• Broader-spectrum initial empiric therapy is recommended for complicated UTIs due to obstruction 3
• Treatment must address both the infection and the underlying urological abnormality 3
• Early intervention for urinary drainage (within 72 hours) may improve outcomes, particularly regarding renal replacement therapy requirements 4

Common Pitfalls to Avoid

• Failing to obtain urine cultures in patients with risk factors for complicated UTIs 3
• Treating with antibiotics alone without addressing the obstruction 1
• Delaying intervention for urinary drainage, which may result in worse outcomes 4
• Overlooking the possibility of multidrug-resistant organisms in recurrent UTIs 3