Post-obstructive diuresis

Background

A rare but potentially lethal complication associated with the relief of (most commonly, chronic) urinary obstruction[1]
May result in dehydration, electrolyte imbalances, and death if not adequately treated[1]

Polyuria after relief of urinary tract obstruction (frequently Foley catheter placement)
Some patients may experience hematuria, which is rarely clinically significant [2]

Osmotic diuresis
- Hyperglycemia
- Mannitol
Drugs: diuretics, caffeine, acetazolamide, lithium
Hypercalcemia
Hypokalemia
Diabetes insipidus
Cushing's syndrome, primary hyperaldosteronism
Inability to concentrate urine (e.g. chronic pyelonephritis, sickle cell disease, amyloidosis
Post-obstructive diuresis
Early renal failure
High fluid intake
- Excess IVF
- Psychogenic polydipsia

Urine is usually hypotonic with large amounts of sodium chloride, potassium, phosphate and magnesium [3]
Urine Output > 125 - 200mL/hour after relief of obstruction for at least 3 consecutive hours[4]
Urine Osmolarity > 250mosm/kg [5]

Halbgewachs C, Domes T. Postobstructive diuresis. Can Fam Physician. 2015 Feb; 61(2): 137–142.
Nyman MA et al. Management of urinary retention: rapid versus gradual decompression and risk of complications. Mayo Clin Proc. 1997;72(10):951
Jameson et al. Harrison's Principles of Internal Medicine 20th edition. Chapter 313.
Nyman et al. Management of Urinary Retention: Rapid Versus Gradual Decompression and Risk of Complications. Mayo clinic proceedings. 1997;72:951-956.
Reynard et al. Oxford Handbook of Urology. Chapter 4. 2005. Oxford University Press.

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