Obstructive Lesions and Infection in the Urinary Tract
The common urological dictum that obstructive lesions and infection of the urinary tract are bad bedfellows has been established by universal clinical experience. Not only does obstruction predispose to infection, but treatment of the infection in the presence of obstruction is usually quite hopeless until the obstruction is relieved. Thus the recognition of obstruction is essential to proper treatment of urinary infections and in the present era of effective chemotherapy, one criterion which may be used in suspecting the presence of an obstructive lesion is the failure of the infection to respond to chemotherapeutic agents. Chronic urinary infection should, therefore, be considered to be due to urinary stasis until proved otherwise. The relief of the obstruction is a surgical problem in the majority of instances.
Obstructive lesions in the urinary tract are of many types and may be partial, complete, or intermittent. They may occur anywhere from the calices to the urethral meatus and may be either congenital or acquired. An important consideration from the point of view of management is the location of the obstruction, that is, whether it is below or above the bladder and, in turn, whether the supravesical lesion is unilateral or bilateral.
That obstruction predisposes to infection finds many examples and sooner or later infection is almost sure to complicate any obstructive lesion. The increased susceptibility of an obstructed urinary tract to infection is due to the resulting congestion in the kidney which reduces the resistance of the renal cells and pelvic epithelium to bacteria. . .