The impact of renal impairment on the management of patients with lower urinary tract obstruction.
One hundred patients with lower urinary tract obstruction (LUTO) seen over a 10-month period were prospectively studied. Nineteen (19%) had an elevated serum creatinine (> 125 mumol/l); 13% had benign prostatic hyperplasia (BPH); 4% had urethral strictures; and two had congenital anomalies. Though urethral strictures are more common than BPH they cause less renal impairment, probably because the patients are younger and also because a urinary fistula may form proximal to the stricture when the intravesical pressure rises very high. Eighty per cent of the patients with renal impairment had a urinary tract infection (UTI), and in these the reduction in serum creatinine following relief of obstruction was slow and erratic. In three patients who did not have UTI the serum creatinine dropped steadily at a rate which varied from 6.8-845 mumol/l/week following continuous bladder drainage and appropriate supportive management. All patients with elevated serum creatinine had delayed surgery and required prolonged preoperative hospitalization, with a resultant sharp increase in the cost of their treatment.
Ogbonna
B C
BC
Department of Surgery, Jos University Teaching Hospital, Nigeria.
Madziga
A G
AG
Anteyi
E A
EA
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000150:complications; D051437:Renal Insufficiency / Q000453:epidemiology / Q000209:etiology*; D014521:Urethra / Q000473:pathology; D014524:Urethral Obstruction / Q000150:complications*; D014525:Urethral Stricture / Q000150:complications; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000209:etiology
D000900:Anti-Bacterial Agents; D003404:Creatinine