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Updated August 05, 2015.

Urinary tract problems are quite common after surgery.  Luckily, most of these problems are minor and resolve quickly in the days following surgery.  More severe complications, such as kidney failure, are possible but are far less likely to occur.  Typically, the more severe kidney issues are seen in patients who require extended treatment after surgery, especially those who require intensive care in the days and weeks following a procedure.

The Urinary Tract

The urinary tract is made up of four parts, which are sterile (free of bacteria) in a healthy individual: 

Kidneys: These vital organs filter the blood. The material removed from the blood is turned into urine so that it can leave the body.

The Ureters: These tubes carry urine from the kidneys to the bladder.  

The Bladder: This is where urine is stored until there is an urge to urinate.  

The Urethra: This is the tube through which urine travels from the bladder to the outside of the body.

Common Kidney and Urinary Tract Issues After Surgery

Urinary Tract Infection (UTI): A urinary tract infection, which is an infection that occurs in one or more of the kidneys, ureters, bladder or urethra, is one of the most common complications after surgery. Thankfully, a urinary tract infection is typically able to be treated quickly and easily with an antibiotic. 

The primary reason that urinary tract infections are so common after surgery is the use of urinary catheters.  For most patients having a surgery with general anesthesia, a catheter is placed to empty the bladder during the procedure.

  This catheter, also known as a foley catheter, is inserted using sterile techniques to help prevent infection.  Unfortunately, having a foreign body in the urethra and bladder, no matter how clean it may be, can cause irritation and lead to infection.  Proper cleansing can help reduce the risk of infection, but the goal is to remove the catheter as soon as is possible after surgery.  

While a urinary tract infection is typically easily treated, in serious cases a condition called urosepsis can result, which can be a serious complication.

Urinary Retention: This is a condition that ranges in severity from a minor inconvenience to very serious.   The patient no longer feels the urge to urinate, or is unable to urinate completely--or at all--after surgery.  It is also referred to as “neurogenic bladder” or “neurogenic bladder dysfunction.”

In minor cases, the patient no longer feels the need to urinate, but is able to urinate when they choose.  They do not experience the sensation that tells them to go to the bathroom, but can go without difficulty when they choose.  This can lead to a urinary tract infection, as holding urine longer than necessary can be a cause of UTI.  As long as the patient remembers to urinate routinely, this issue typically passes in the days or weeks after surgery. 

Other patients feel the urge to urinate but they are unable to completely empty the bladder. Holding more than 3 ounces in the bladder after urinating is considered abnormal and is a risk factor for urinary tract infections.

Not being able to empty the bladder is a very serious complication that leads to a visit to the emergency room or being kept in the hospital until the issue resolves.  This is because the inability to pass urine will first lead to the bladder becoming stretched full of urine, like a balloon.  When the bladder fills up, urine starts to back up, and can damage the kidneys permanently.  This issue requires a urinary catheter to drain the urine from the bladder and must be closely monitored to prevent damage to the urinary tract.

Low Urine Output: This means that the body is producing less urine than is expected.  Urine output is closely monitored after surgery, because urine output is a good indication of how the body is recovering from surgery.  

In most cases, low urine output can be quickly and easily improved by drinking fluids or receiving more fluids in an IV.  If these simple interventions are not successful, a more aggressive treatment plan may be necessary.

Acute Kidney Injury: This is a medical condition that occurs very quickly, in less than 7 days, and results in the kidneys working less efficiently.  Also known as acute renal failure, this condition is usually discovered with blood work that shows the creatinine level in the blood to be increasing, and is often reversible.  

Ideally, the patient is provided with more fluids, and that allows the kidneys to work better, but some acute kidney injuries are more serious and requires specialized treatment by a nephrologist--a kidney specialist--and potentially further testing to determine the source of the issue.  

Some patients may find that their kidneys are not the issue, the kidneys may be responding to a problem in another part of the body, such as low blood pressure or a heart condition.  In many cases, once the real problem is addressed, the kidneys are able to return to their normal level of function.

Kidney Failure:  There are two main types of kidney failure, acute and chronic. Kidney failure is the name for when the kidneys are unable to filter the blood well enough to keep an individual healthy.

Acute Kidney Failure: The long term outcome for acute kidney failure is often good, this condition starts suddenly, and with appropriate treatment, kidney damage can often be minimized.  The cause may be as simple as low blood pressure and may be improved by increasing blood pressure levels.

Some people regain their normal level of kidney function if they are treated quickly and others may be left with decreased kidney function that is not noticeable for the most part.  Severe cases of acute kidney failure can, in the worst cases, become chronic renal failure, meaning the condition does not improve and becomes a life-long issue. Thankfully, these cases are rare.

Chronic Kidney Failure: Also known as chronic renal failure or chronic renal insufficiency, is a very serious condition. Chronic renal failure typically develops over the course of years, and for most patients, the function of the kidneys gets worse over the course of months, years and sometimes even decades.  

The cause of the failure may seem to be unrelated to the kidney, it may be uncontrolled high blood pressure, poorly controlled diabetes, or even a massive infection in the bloodstream that decreases blood pressure for an extended period of time.   

Patients who develop the worst stage of chronic kidney failure are eventually treated with dialysis.  There is no cure for end stage kidney failure, but some patients are “cured” with a kidney transplant. 

Source:

Kidney Disease A-Z. NIDDK. Accessed July, 2015. http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/Pages/default.aspx