Q: Two months back I was diagnosed with hydronephrosis in my right kidney. Tests like IVP and DTPA scan revealed mildly impaired kidney function with significant thinning of the cortex. The doctor said that the cause was a right pelvi-uretero junction (PUJ) obstruction and therefore, I had pyleoplasty done. However, I continue to feel the same discomfort which was present before the surgery, namely frequent urination with insufficient output and a feeling of incomplete emptying of the bladder. I had an ultrasound of the lower abdomen done before and after the surgery, which on both occasions revealed that I was retaining abnormal amounts in my bladder despite my best efforts. The post-void residue is 150 cc. I want to know if there is some blockage in my urethra or somewhere else, which is causing this retention and also if this has anything to do with hydronephrosis and kidney dysfunction?

A:Based on the clinical history and limited symptomology, you probably suffer from chronic urinary retention characterised by an ongoing inability to completely empty the bladder during voiding. Incomplete bladder emptying may result from either impaired bladder muscle contractility and/or bladder outlet obstruction. Usual symptoms may include weak urinary stream, dribbling, increased frequency of urination with the feeling of hesitancy and incomplete emptying, interrupted voiding, and straining to empty. Elevated post-void residual (PVR) as in your case can lead to an increased risk of acute urinary retention, urinary tract infection, or upper tract pathology such as pyelonephritis (infection of the kidney and its urinary ducts), hydronephrosis or impaired renal function. Bladder outlet obstruction is relatively rare in women though often it involves a gynaecologic cause. It usually involves pelvic organ prolapse (e.g. cystocele, uterine prolapse) causing mechanical obstruction of the urethra at the bladder neck leading to urinary retention. Other usual causes include poor sphincter relaxation at urethral level, neurological disease affecting the bladder contractility, intake of medications including opiate analgesics interfering with bladder and sphincter control and lastly psychogenic cause which is proven after excluding above causes. Cause of urinary retention remains elusive in over one-third cases despite all the tests. You require a thorough evaluation, preferably by an urologist, including urodynamic testing. This testing evaluates bladder function by measuring pressure and volume of fluid in the bladder during filling, storage, and voiding, measures the urine flow rate and assess urethral function. It aids in understanding physiologic mechanisms of lower urinary tract dysfunction, thereby improving the accuracy of diagnosis and facilitating targeted treatment.