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A - MSRA Renal and Urinary [17] > [12] Urinary Tract Obstruction > Flashcards

[12] Urinary Tract Obstruction Flashcards

1
Q

What are the categories of causes of urinary tract obstruction?

A

Luminal
Mural
Extramural

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2
Q

What are the luminal causes of urinary tract obstruction?

A

Stones
Blood clots
Sloughed papilla

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3
Q

What are the mural causes of urinary tract obstructions?

A

Congential or acquired stricture
Tumour
Neuromuscular dysfunction

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4
Q

What tumours can cause urinary tract obstructions?

A

Renal
Ureteric
Bladder

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5
Q

What are the extramural causes of urinary tract obstruction?

A

Prostatic enlargement
Abdominal/pelvis mass or tumour
Retroperitoneal fibrosis

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6
Q

How does acute upper urinary tract obstruction present?

A

Loin to groin pain

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7
Q

How does acute lower urinary tract obstruction present?

A

Severe suprapubic pain with distended, palpable bladder

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8
Q

What causes suprapubic pain and palpable bladder in acute lower urinary tract obstruction?

A

Bladder outflow obstruction

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9
Q

How does chronic upper urinary tract obstruction present?

A

Flank pain

Renal failure

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10
Q

How does chronic lower urinary tract obstruction present?

A 
Frequency
Hesitancy
Poor stream
Terminal drippling
Overflow incontinence
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11
Q

What may be found on examination in chroinc lower urinary tract obstruction?

A

Distended, palpable bladder

Sometimes large prostate on PR

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12
Q

What investigations are done in urinary tract obstruction?

A

Bloods
Urine dip and MC&S
Imaging

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13
Q

What imaging is done in urinary tract obstruction?

A

Ultrasound
Anterograde/retrograde ureterograms
Radionucleotide imaging
CT/MRI

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14
Q

What might be found on US in urinary tract obstruction?

A

Hydronephrosis or hydroureter

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15
Q

What do anterograde/retrograde ureterograms allow in urinary tract obstruction?

A

Therapeutic drainage

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16
Q

What is the purpose of radionucleotide imaging in urinary tract obstruction?

A

Check renal function

17
Q

How is an upper urinary tract obstruction managed?

A

Nephrostomy

Ureteric stent

18
Q

How is a lower urinary tract obstruction managed?

A

Urethral or supra-pubic catheter

19
Q

What might happen following catheterisation in a lower urinary tract obstruction?

A

May be a large post-obstructive diuresis

20
Q

What are the common complications of ureteric stents?

A

Infection
Haematuria
Trigonal irritation
Encrustation

21
Q

What are the rare complications of ureteric stents?

A

Obstruction
Ureteric rupture
Stent migration

22
Q

What are the causes of urethral stricture?

A

Trauma
Infection
Chemotherapy
Balantitis xerotica obliterans

23
Q

Give two examples of urethral trauma that can cause strictures

A

Instrumentation

Pelvic fractures

24
Q

Give an example of an infection that can cause urethral strictures

A

Gonorrhoea

25
Q

How do urethral strictures present?

A 
Hesitancy
Strangury
Poor stream
Terminal dribbling
Pis en deux
26
Q

What is done on examination in urethral stricture?

A

PR to exclude prostatic cause
Palpate urethra through penis
Examine meatus

27
Q

What investigations are done in urethral stricture?

A

Urodynamics
Urethroscopy and cystoscopy
Retrograde urethrogram

28
Q

What is found on urodynamics in urethral strictures?

A

Decreased peak flow rate

Increased micturition rate

29
Q

How are urethral strictures managed?

A

Internal urethrotomy
Dilatation
Stent

30
Q

Why might obstructive uropathy go unnoticed for days?

A

Because acute retention on a chronic background may not produce pain

31
Q

What might serum creatinine be in obstructive uropathy?

A

Up to 1500uM

32
Q

What is the long-term outcome of obstructive uropathy?

A

Renal function should return to normal over days, but some background impairment may remain

33
Q

What are the complications of obstructive uropathy?

A 
Hyperkalaemia
Metabolic acidosis
Post-obstructive diuresis
Na and HCO3 losing nephropathy
Infection
34
Q

What causes post-obstructive diuresis?

A

Kidneys produce a lot of urine in the acute phase after relief of obstruction

35
Q

What do you need to ensure with post-obstructive diuresis?

A

Need to ensure you keep up with loses to avoid dehydration

36
Q

What might cause Na and HCO3 losing nephopathy in obstructive uropathy?

A

Post-obstructive diuresis might cause loss of Na and HCO3

37
Q

What management might Na and HCO3- losing nephropathy require?

A

Replacement with 1.26% NaHCO3

A - MSRA Renal and Urinary [17] (17 decks)

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