A patient with a urinary obstruction is classed under which ASA grade?

• A. I
• B. II
• C. IV
• D. III

Answer: (C)

Assessing ASA status hinges on how a systemic disease affects the patient’s risk of life-threatening complications. A urinary obstruction can lead to serious, rapidly evolving problems—acute kidney injury, electrolyte disturbances, infection or sepsis, and potential hemodynamic instability. When such a condition is present and poses a constant threat to life, it fits ASA IV: severe systemic disease that is a constant threat to life. If the obstruction were associated only with mild systemic issues, ASA II, or a severe systemic disease that limits activity but isn’t life-threatening, ASA III, would apply, but the imminent risk from obstructive uropathy pushes it to ASA IV.