Studies of metabolism of water and electrolytes before and after continuous drainage were made for 27 patients with lower urinary tract obstructions, and 3 cases with ureteral obstructions as control.
In about half the cases, plasma Na, K & Cl concentrations, hematocrit findings, plasma total protein, urinary Na, K and Cl outputs, T-1824-space and SCN-space were studied at 1, 2, 3, 6, 12 and every 24 hours after the relief of obstructions
1) In the cases whose renal functions were normal or slightly impaired, blood chemistry studies before urethral catheter drainage proved that plasma electrolyte abnormalities were not only slight or absent, but all of these patients presented also good general physiological conditions and no dehydration symptom excepting in water-restricted cases. After the drainage, considerable fluctuations of chemical components of plasma occurred during half a day. That is, the concentrations of plasma electrolytes (Na, K & Cl) were reduced temporarily after relief of obstructions, concentrations of plasma protein and hematocrit values decreased too at the same time. It was, therefore, suggested that a hydremic state had occurred within this short period. These levels became higher in all cases thereafter, and returned to normal level within 12 hours or one day after the relief. In many cases water balance became negative shortly after the relief of obstructions, but there were no cases which showed remarkable polyuric state. All of these patients in this group made smooth recoveries without particular fluid administration and could be operated upon successfully, excepting one hypertensive patient who died of cerebral hemorrhage which occurred after sudden hypotension caused by the relief of obstruction.
2) The results of animal experiments with dogs of acute urinary retention, in spite of insufficient fluid and salt supply, made it appear that transitory hydremia after the bladder drainage might occur, coinciding with the clinical cases of slight renal dysfunction.
3) In advanced renal failure group, high degrees of water and electrolyte abnormality were exhibited already before admission to the hospital in may cases, and severe changes and great deviations of the plasma electrolytes level from normal took place after the relief of obstruction; especially negative balance of water and sodium persisted, and there was a great tendency to dehydration and hyponatremia. It is important that adequate fluid supply should be prescribed in such cases.
It must be noted that the severe chemical imbalance may be caused by the relief of obstruction, though the components of the plasma before the drainage are in the normal range. Repeated examinations are therefore very important. There were some uncommon cases that demonstrated plasma potassium abnormalities, and there were also some cases which showed unsuspected fluctuation of plasma sodium levels resultant from the sodium administration, There are dangerous possibilities that a vicious cycle may result which would make renal failure more advanced by the combination of circulatory insufficiency because of water and electrolyte imbalance.
In this group of sicknesses it is very difficult task to make sure of the operable state of patients due to the long-standing renal hypofunction and poor general conditions in spite of continuous bladder drainage for a long time.
It should be emphasized that early diagnosis and proper treatment before outbreaking of irreversible renal damage are necessary for the cases of lower urinary tract obstructions.

View full abstract