[Bilateral hydronephrosis as a result of opioid-induced bowel spasm in a patient with an ileal conduit]

Area of Science:

• Urology
• Nephrology
• Pharmacology

Background:

• A 47-year-old woman with a history of spina bifida and ileal conduit presented with symptoms suggestive of ureteral reimplantation site stenosis.
• Her medical history included recent escalation of opioid medication for neuropathic pain management.

Observation:

• The patient experienced left flank pain, bilateral hydronephrosis, and oliguria.
• Initial assessment suggested recurrent stenosis at the ureteral implantation site, with percutaneous nephrostomy placement and discussion of open ureteral reimplantation.

Findings:

• Following a reduction in opioid dosage, the patient's hydronephrosis resolved.
• This clinical course indicated that opioid-induced bowel spasm was the likely cause of the urinary obstruction, rather than anatomical stenosis.

Implications:

• This case highlights the importance of considering medication side effects, specifically opioid-induced bowel spasm, in the differential diagnosis of urinary obstruction in patients with ileal conduits.
• Conservative management, such as medication adjustment, may obviate the need for surgical intervention in select cases.
• Further research into the mechanisms and prevalence of opioid-induced gastrointestinal and urinary complications is warranted.