Emergency Management of Obstructive Uropathy in Resource-constrained Settings: Current Concepts and Surgical Perspectives

Abstract

Background and Aim: Obstructive uropathy is a common urological emergency and an important reversible cause of acute kidney injury. Delayed recognition and inadequate management may lead to irreversible renal damage, sepsis, and increased mortality. Although standardized guidelines exist for the management of urinary obstruction, their implementation remains challenging in many healthcare systems, particularly in resource-constrained settings where access to imaging and specialist care may be limited. A practical, clinically oriented synthesis of current management principles is therefore necessary to guide decision-making in diverse clinical environments. Methods: A structured narrative review of the literature was conducted using electronic databases including PubMed/MEDLINE, Scopus, and Google Scholar. Relevant articles addressing etiology, pathophysiology, clinical presentation, diagnostic strategies, emergency decompression techniques, complications, and management approaches in resource-limited settings were identified. Priority was given to guideline-based evidence, randomized trials, systematic reviews, and clinically relevant observational studies. Selected findings were synthesized into clinically oriented sections supported by summary tables and a management algorithm. Results: Obstructive uropathy arises from multiple etiologies, with urolithiasis, malignancy, benign prostatic hyperplasia, and ureteric strictures representing the most common causes in emergency practice. Early recognition of high-risk features—including infection, bilateral obstruction, solitary kidney involvement, and acute kidney injury—is essential in guiding urgent intervention. Both ureteric stenting and percutaneous nephrostomy remain effective methods of decompression, with procedure selection influenced by patient condition, anatomical factors, and resource availability. In resource-constrained environments, ultrasound-based evaluation, early stabilization, and timely referral play a critical role in improving outcomes. Advances in portable imaging, training programs, and referral networks have the potential to further enhance patient care in underserved settings. Conclusion: Emergency management of obstructive uropathy requires timely diagnosis, prompt decompression, and careful follow-up to prevent irreversible renal injury. Adaptation of established management principles to local resource availability remains essential for improving outcomes. Strengthening diagnostic capacity, procedural training, and referral systems may reduce morbidity and mortality associated with obstructive emergencies, particularly in low-resource healthcare settings.