Review Question - QID 101032

The patient’s clinical scenario suggests urethral obstruction due to prostatic hyperplasia. Prolonged obstruction can lead to hydronephrosis as seen in the patient’s CT scan.

Urinary hesitancy, urinary intermittency, straining to void, and urinary dribbling are symptoms associated with urethral obstruction due to prostatic hyperplasia, which can be felt on rectal examination in about half of all cases. Prolonged urinary obstruction can cause unilateral or bilateral hydronephrosis. Hydronephrosis can be acute or chronic and is marked by a dilated ureter and/or renal pelvis.

Edwards reviews benign prostatic hyperplasia (BPH). Symptoms include urinary hesitancy, weak stream, nocturia, incontinence, and recurrent urinary tract infections. Acute urinary retention is rare and requires bladder catheterization. Irreversible renal damage due to urinary obstruction is possible but rare.

Sutaria et al. review hydronephrosis in the elderly due to urinary tract obstruction. Lower urinary tract obstruction should always be evaluated in individuals with declining kidney function. Removing any present obstruction can rapidly reverse renal decline, while chronic obstruction can produce permanent kidney damage.

Figure A is a CT scan showing grossly dilated ureters due to hydronephrosis.

Incorrect Answers:
Answer 2: Hypertension, hematuria, and abdominal discomfort are symptoms of autosomal dominant polycystic kidney disease.
Answer 3: Hypoperfusion of the kidneys is responsible for prerenal azotemia. Hemorrhage, shock, volume depletion, congestive heart failure, and narrowing of the renal artery are common causes of this condition.
Answer 4: Prostate cancer and benign prostatic hyperplasia (BPH) may cause elevated serum PSA. Elevation in serum PSA, however, is not a direct cause of hydronephrosis.
Answer 5: Multiple endocrine neoplasia type I (MEN I) refers to a group of linked tumors in the pituitary, pancreas, and parathyroid glands. None of these conditions produces hydronephrosis.