Malformations and infections of the urinary tract, and their influence on driving
Kidney and ureter malformation
Polycystic kidney disease:This congenital disease is caused by malformation of the nephrons, which have blind ends and do not drain. As glomerular function remains intact, cystic degeneration ensues.
The clinical manifestations are uncharacteristic pain in the lumbar region, macrohaematuria, frequently accompanied by colic, pressure sensation in the upper hemiabdomen, headaches in the case of hypertension, nausea and vomiting in the case of progressive renal failure and shivering and fever when there are infectious complications.
Abnomalities in the positioning of the kidneys: These include a series of abnormalities that will only interfere with driving in certain cases, such as malrotations, renal dystrophy and different types of renal sinfisis.
These malformations will not generally present clinical symptoms as renal function is generally normal.Nevertheless, the unusual route of the ureters and unusual vessels produce abnormalities in the elimination of urine, which can be responsible for the formation of calculus and recurring pyelonephritis.
Therefore, they can be manifestations of secondary diseases such as pyelonephritis, nephrolithiasis and urinary estasis.
- Floating kidney: When the kidney is only loosely attached to the retropeitoneal cavity, the kidneys can move around in such a manner that the ureters and renal veins get entangled, causing functional difficulties.
- This can cause pain in the lumbar region, proteinurea or haematuria after exertion, recurrent infection of the urinary tracts, hypertension or estasis of the ureters.
Multiple ureter abnormalities: These are abnormalities that occur during the development of the embryo and consist of double ureters (either complete or incomplete), with possible renal duplication.
Ectopic ureters are common, as are vesicoureteral reflux, urinary estasis, recurrent infections, litiasis and on occasions urinary incontinence through the ectopic ureteral orifice.The symptoms depend on the particular abnormality, but in general are due to infectious complications due to estasis, litiasis and reflux.
- Ureterocele and stenosis of the ureter: Difficulties in urinary drainage produces estasis and recurrent infection, which can affect the corresponding kidney. The treatment is surgical.
Urinary tract infections: Acute cystitis produces dysuria, pollakuria, tenesm and suprapubic pain.
Acute bacterial pyelonephritis causes fever, lumbar pain, chills, a general feeling of being unwell, vomiting, dysuria and paralytic reflex ileus.
Chronic pyelonephritis causes recurrent infections that lead to fibrosis, resulting in renal sclerosis and progressive functional failure.
The infectious condition is controlled with oral antibiotic therapy and hydration.
In more serious cases, the patient will be admitted to hospital where intravenous antibiotics will be administered, leading to free urinary flow and the control of possible complications.
Acute bacterial prostatitis: The acute inflammation of the prostate gland produces fever, chills, dysurea and perineal pain with rectal tenesm. Urinary retention is frequent.
The patient must rest during the acute stage with hydration and antibiotic treatment until the clinical symptoms resolve.
Chronic prostatitis: This can cause lower back pain, perineal or testicular discomfort, dysurea and difficulty urinating.
Treatment with antibiotics will resolve the clinical condition, although there is often resistance, and prolonged treatment or changes in medication may be required. Preventative measures must be associated to prevent infections.
Acute orchiepididymitis: This disease is characterised by the rapid onset of pain, oedema of the epididymal, fever, a general unwell condition and chills.
It is often accompanied by urinary tract infections, polakyuria, stress incontinence and dysuria.
The patient must rest during the acute stage with antibiotic treatment until the clinical symptoms resolve.
Advice on Kidney and ureter malformation
- Patients may drive during periods when they are asymptomatic.
- When complications such as bleeding or infections occur, the patient should be advised not to drive until the episode is resolved.
- Poorly-controlled arterial hypertension precludes driving.
- Patients are unable to drive safely while suffering from progressive renal failure because of its associated symptoms.
- The specialist will advise patients not to drive if they are suffering from any complications, in any and all cases where they consider it prudent and for a period of time they consider advisable, for the patient’s safety.
Advice on Abnomalities in the positioning of the kidneys and Floating kidney
- If the changes in and mobility of the kidneys does not produce symptoms, the patient may drive.
- In symptomatic cases with pain, infection, hypertension or haematuria, driving is not advisable until the medical or surgical treatment has resolved the clinical signs and symptoms.
- A specialist will inform the patient in each case when he has recovered sufficiently to be able to drive again safely.
Advice on Multiple ureter abnormalities
- During symptomatic episodes, treatment, rest and specialist tests are required, and when the patient recovers from the clinical symptoms, driving will once again be permitted.
- The definitive solution to malformation is usually surgical, the complexity of which depends on the individual case. A urologist will be able to decide when the patient has recovered without sequelae and is able to drive.
Advice on Ureterocele and stenosis of the ureter
- During infections accompanied by fever, driving is not recommended.
- The definitive treatment, if successful, will allow the patient to drive without adverse effects, so long as the specialists gives his permission.
Advice on Urinary tract infections
- During the acute febrile period, driving is not permitted.
- When the clinical symptoms begin to improve, driving should only be done over short distances which will allow the bladder to be emptied whenever the driver feels the need, avoiding urine retention that will be detrimental to the evolution of the clinical situation.
- Progressive renal failure makes it impossible for the patient to drive unless suitable treatment is administered and the cause of the repeated infections is eliminated.
Advice on Acute bacterial prostatitis
- The acute episode means the patient must not drive, and this should be made clear to the patient.
Advice on Chronic prostatitis
- It is recommended that long journeys be avoided, and that seats should be covered with cloth, avoiding synthetic leather and leather, and the driver’s clothes should be light and allow the skin to breathe.
- If travelling is unavoidable, the driver must stop more frequently to rest, drink water, and empty the bladder.
Advice on Acute orchiepididymitis
- The acute episode of prostastitis means the patient must not drive, and this should be made clear to the patient.