Urinary Transport Disorder, Obstructive Uropathy, Refluxuropathy: Causes

Pathogenesis (disease development)

Obstructive uropathy results from a narrowing or obstruction of the outflow of urine from the kidney. The blockage causes urine to accumulate, dilating the upstream areas of the genitourinary tract. As it progresses, renal dysfunction occurs without adequate treatment. Vesicorenal reflux is an unphysiologic backflow of urine from the bladder through the ureters (ureters) into the renal pelvis. Urinary reflux paves the way for bacterial ascension and infection. This manifests as recurrent urinary tract infections (UTIs) to high-fever pyelonephritis (renal pelvic inflammatory disease).

Etiology (causes)

Biographic causes

  • Genetic burden
    • Genetic diseases
      • Spina bifida – cleft formation in the spine occurring during embryonic development (sporadic, rarely familial).
  • Malformations
    • Congenital (congenital) ureteral and urethra narrowing/ureteral and urethral narrowing (stenoses and strictures, respectively) → obstructive uropathy.
    • Congenital reflux based on malposition of the ureteral orifice in the bladder wall → vesicorenal reflux.

Disease-related causes.

Congenital malformations, deformities and chromosomal abnormalities (Q00-Q99).

  • Malformations of the genitourinary system, unspecified.
  • Congenital ureteral outlet stenosis
  • Megaureter – usually congenital dilation of one or both ureters (>10 mm).
  • Spina bifida (see below “Biographical Causes”).

Blood-forming organs – immune system (D50-D90).

  • Sarcoidosis – granulomatous inflammation; considered an inflammatory multisystem disease.

Endocrine, nutritional, and metabolic diseases (E00-E90).

Cardiovascular system (I00-I99).

  • Aneurysm (wall outpouching) of the pelvic vessels.
  • Aortic aneurysm – outpouching of the wall of the aorta.
  • Ovarian vein thrombophlebitis/inflammation of the ovarian vein (rare postpartum complication).

Infectious and parasitic diseases (A00-B99).

  • Schistosomiasis – worm disease (tropical infectious disease) caused by trematodes (sucking worms) of the genus Schistosoma (couple flukes) (infection of the urinary bladder with Schistosoma haematobium, a parasite).
  • Tabes dorsalis – late stage syphilis characterized by neurological symptoms.
  • Tuberculosis (consumption).

Neoplasms – tumor diseases (C00-D48)

Psyche – nervous system (F00-F99; G00-G99)

Pregnancy, childbirth and puerperium (O00-O99)

  • Extrauterine pregnancy – pregnancy outside the uterus; extrauterine pregnancy is present in approximately 1% to 2% of all pregnancies: Tubalgravidity (ectopic pregnancy), Ovariangravidity (pregnancy in the ovary), Peritonealgravidity or Abdominalgravidity (pregnancy in the abdominal cavity), Cervicalgravidity (pregnancy in the cervix).
  • Puerperal ovarian vein thrombophlebitis (POVT) – resulting mainly right-sided hydronephrosis (during pregnancy).

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

  • Pelvic floor subsidence
  • Blood coagulation in hematuria (blood in the urine)
  • Endometriosis – benign but painful proliferation of endometrium (lining of the uterus) outside the uterine cavity.
  • Ureteral stricture (ureteral narrowing).
  • Megaureter – usually congenital dilation of one or both ureters (>10 mm).
  • Cicatricial strictures (high-grade narrowing) of the urinary tract.
  • Kidney stone
  • Ovarian abscess – accumulation of pus in the ovary.
  • Prostatic hyperplasia (BPH) – benign enlargement of the prostate.
  • Retroperitoneal fibrosis (synonyms: retroperitoneal fibrosis; Ormond’s disease; Ormond’s syndrome; in Anglo-American writing: Albarran-Ormond syndrome, “Gerota’s fascitis” or “Gerota’s syndrome”) – slowly increasing connective tissue proliferation between the posterior peritoneum (peritoneum) and the spine with walled-in vessels, nerves and ureters (ureters).
  • Ureterocele – protrusion of the mucosa of the intramural ureteral segment into the bladder lumen.
  • Ureteral polyp
  • Ureteral stone (ureteral stone)
  • Urolithiasis (urinary stone disease), unspecified.

Injuries, poisonings, and other consequences of external causes (S00-T98).

  • Foreign body, unspecified

Other causes

Medications

Antidepressants, antiparkinsonian agents, antipsychotics (neuroleptics), and substance groups containing tertiary and quaternary amines, have adverse effects such as urinary retention because of their anticholinergic component (see also under “Anticholinergic effects of drugs”):