1.6 Stenosis and fistulas in the urinary tract Flashcards
causes of stenosis in UT
TICI
o Trauma
o Infection (UTI)
o Congenital anomaly (UPJ obstruction: ureteral strictures , uretheral strictures)
o Iatrogenic (scarring from previous surgery,radiotherapy, stones, tumor)
symptoms of stenosis of UT
o Difficulty voiding, difficulty emptying the bladder
o Dysuria
o Drippling
o Urinary incontinence
o UTI
o Weak urine stream
o Decreased ejaculation force
o Symptomless in some cases
treatment of UT stenosis
o Dilatation
o Urethrotomy
o Anastomotic repair for short posterior urethral strictures
o Open surgical reconstruction
o Catherization
fistulas in the urinary tract
An abnormal opening between the urinary tract and another nearby organ, such as the
colon or the vagina, or the outside.
- The connection allows for the passage or leakage of urine, feces or other matter to pass where it shouldn´t
fistulas of UT are more common in which gender
More common in women
but not very common in developed countries (due to adequate healthcare during childbirth
etiology of fistulas in UT
o Any damage to the tissue of the urinary tract, pelvic region or vagina can create optimal conditions for fistula formation
- Injury/accident
- Surgery (hysterectomy, C-section)
- Malignancies in pelvic region
- Radiation treatment
- IBD or diverticulitis
- Problems from episiotomy incision for childbirth (deep tears, infection)= is a incision in the tissue between the vaginal opening and the anus during childbirth
- Infections (less often)
Symptoms of fistula in UT
- Frequent UTI
- usually painless
- fluid/urine/feces leaking from vagina,
- foul-smelling gas or discharge,
- passing gas from urethra while urinating, frequent UTIs,
- irritation in vulva,
- abdominal pain
diagnosis of fistulas in UT
Patient history, urine sample, CBC ( infection?)
* Excretory urogram : contrast dye injected to urinary tract, X-ray to examine the bladder
* CT urogram/urography: dye into vein: evaluate vagina and lower urinary tract
* Dye test : bladder filled with a dye and patient coughs or bears down: look for bladder leakage by checking dye in vagina
* Cystoscope
* Cystogram : bladder fills with contrast dye to evaluate for location of urinary leakage
* Retrograde pyelogram : similar to excretory urogram, but specifically for leakage between vagina and ureter
* Fistulogram: X-ray
* Flexible sigmoidoscopy
* MRI
treatment of fistulas in UT
Conservative if small,
urinary catheter,
surgical repair
Ureteral stricture def
narrowing of ureter
Ureteral stricture etiology
CUSUT
- Congenital (eg. UPJ obstruction)
- UTIs
- Scarring from previous surgery,
- Urinary stones,
- Tumor
Ureteral stricture symptoms
- flank pain,
- feeling of fullness,
- hematuria,
- nausea,
- UTIs,
- pain worsen with increased fluid/alcohol
pain worsen with increased fluid/alcohol is a symptoms of what
ureteral stricture
Ureteral stricture diagnostics
- US,
- CT,
- MRI,
- renal nuclear medicine scan,
- retrograde ureteroscopy
Ureteral stricture complication
- hydronephrosis,
- kidney infections,
- kidney stones
Ureteropelvic junction obstruction (UPJ) definition
the point of blockage is where the ureter meets the collecting system of the kidney
Ureteropelvic junction obstruction (UPJ) etiology
- most often congenital,
- abnormal blood supply,
- scar tissue,
- infections,
- earlier treatment for a blockage,
- kidney stones
Ureteropelvic junction obstruction (UPJ) symptoms
- abdominal mass
- back/flank pain
- vomiting
- hematuria
- UTIs
- kidney infection
Ureteropelvic junction obstruction (UPJ) diagnostics
- CT,
- US,
- urine/blood test,
- nuclear scans,
- X-rays of kidney/bladder/ureter,
- voiding cystourethrogram (X-ray of bladder while emptying)
Urethral stricture def
narrowing of urethra due to scarring
Urethral stricture epidemiology gender
male > female
Urethral stricture etiology
- 45% urethral manipulation (eg.
*catheterization,
*prostatectomy,
*prostate brachytherapy,
*correction of hypospadias) - 30% unknown
- 20% bacterial infections
Urethral stricture symptoms
- Feeling as bladder isn’t empty after urinating
- Frequent UTI
- increased urinary frequency, urinary urgency
- loss of bladder control
- dysuria
- edema of penis and surrounding structures,
Urethral stricture diagnostics
- Urethroscopy,
- urethrography (contrast dye into urethra and observe where the
dye progresses using a fluoroscopic X-ray device), - MRI, CT, US
Urethral stricture treatment
- if no significant symptoms : observation
- Urinary retention : suprapubic catheter
- Dilation of stricture with catheters with balloons (stent for several weeks)
- Urethrotomy = cut stricture with laser or scalpel with urethroscopic guidance
- Open surgical removal
Urethral stricture complication
- often reoccur,
- kidney infections and damage,
- stone formation,
- bladder enlargement and dysfunction
Urethrotomy =
cut stricture with laser or scalpel with urethroscopic guidance
types of Urinary fistula
- Vesicovaginal:
*between vagina and bladder. Most frequent type in women.
*Occurs most often because of a previous hysterectomy. Difficult labor can also cause it. - Ureterovaginal: between ureter and vagina; most occur due to prior
hysterectomy or pelvic surgery - Enterovesical: between bladder and bowel: another of the most common urinary fistulas
- Vesicouterine: between bladder and uterus
- Urethrovaginal: between urethra and vagina
- Colovesical: between colon and bladder
- Rectovaginal: between vagina and rectum
are urinary fistulas painful?
no usually painless
Excretory urogram
: contrast dye injected to urinary tract, X-ray to examine the bladder
- Dye test :
bladder filled with a dye and patient coughs or bears down: look for bladder leakage by checking dye in vagina
Retrograde pyelogram what is it specific for
: similar to excretory urogram(contrast dye injected to urinary tract, X-ray to examine the bladder)
but specifically for leakage between vagina and ureter
- Fistulogram
x ray
CT urogram
dye into vein: evaluate vagina and lower urinary tract
Cystogram
bladder fills with contrast dye to evaluate for location of urinary leakage
Treatment of urinary fistulas
most require surgical repair
* Conservative: simple fistula can heal on their own.
*urinary catheter to bypass fistula;
*incase of ureterovaginal fistula we’ll place a stent in the ureter which will help correct the flow from the kidneys to the bladder
- Surgery: Type and location of fistula will determine the type of surgery (vaginal vs. abdominal approach; open vs. laparoscopic)
