Biochemical disturbances in chronic prostatic and urethral obstruction.

Abstract

SUMMARY1. Plasma concentrations of sodium, potassium, chloride, CO2, combining power, urea, and, on occasion, calcium and phosphate have been determined before and after urethral or suprapubic bladder drainage in fifteen patients suffering from chronic lower urinary tract obstruction.2. Two patients died from renal failure within a few days of cystostomy, and one died from heart failure eleven months after cystostomy. One has a permanent cystostomy and one a perinea urethrostomy. Nine patients subsequently and successfully underwent one or other form of prostatectomy; one died two weeks after Tran urethral resection.3. Before bladder drainage, hyperchlorzmia was present in eleven of the fifteen patients, acidosis was present in eight, and urea retention was present in fourteen.4. After bladder drainage, restitution of the plasma electrolyte concentrations occurred within varying periods of time in thirteen patients, and restitution of the blood urea occurred in eight.5. Excretion programs carried out on seven patients before bladder drainage showed radiological evidence, either hydronephrosis or poor concentration of the contrast medium, of renal impairment; biochemical abnormalities were present in all these patients.6. Excretion urograms after bladder drainage showed radiological evidence of improved renal function, either a lesser degree of hydronephrosis or improved concentration of the contrast medium, in five of the seven patients; all five showed biochemical improvement. In two patients the excretion urograms remained unchanged despite biochemical improvement.7. The abnormal values of the plasma electrolytes are attributed to renal tubular dysfunction, which usually recovers after relief of urinary obstruction. Urea retention is attributed to glomerular damage, which is sometimes persistent.8. In the main, no special water or electrolyte therapy was used in the treatment of this series of patients, but it is suggested that extra water and M/6 sodium lactate, preferably by mouth, should be given when there is evidence of dehydration, sodium deficiency, and acidosis. Saline is but rarely indicated.