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Urinary System > Diseases of Urinary Tract Obstruction > Flashcards

Diseases of Urinary Tract Obstruction Flashcards

1
Q

What are two different types of urinary tract obstruction?

A

Upper tract and lower tract

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2
Q

Name different types of upper tract urinary tract obstructions

A
  • Pelvic-ureteric junction
  • Ureter
  • Vesico-ureteric junction
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3
Q

Name different types of lower tract urinary tract obstructions

A
  • Bladder neck
  • Prostate
  • Urethra
  • Urethral meatus
  • Foreskin (i.e. phimosis)
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4
Q

Name intrinsic and extrinsic causes of PUJ obstruction

A 
Intrinsic:
• Stone 
• Ureteric tumour (TCC)
• Blood clot
• Fungal ball

Extrinsic:
• Lymph nodes (tumour)
• Abdominal mass (tumour)

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5
Q

Name intrinsic and extrinsic causes of ureteric obstruction

A 
Intrinsic:
• Stone
• Ureteric tumour (TCC)
• Scar tissue
• Blood clot
• Fungal ball

Extrinsic:
• Lymph nodes (tumour, retroperitoneal fibrosis)
• Iatrogenic
• Abdominal/pelvic mass (tumour, pregnant uterus)

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6
Q

Name intrinsic and extrinsic causes of vesicle-ureteric obstruction

A

Intrinsic:
• Stone
• Bladder tumour
• Ureteric tumour

Extrinsic:
• Cervical tumour
• Prostate cancer

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7
Q

What is the presentation of an upper tract obstruction?

A

Symptoms:
• Pain
• Frank haematuria
• Symptoms of complications

Signs:
• Palpable mass
• Microscopic haemturia
• Signs of complications

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8
Q

What is Frank Haematuria?

A

Macroscopic (visible) haematuria

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9
Q

What investigations are used for upper urinary tract obstruction?

A
  • Urinary dipstick
  • Renal ultrasound
  • U+Es
  • Urea and creatinine
  • FBC - anaemia of chronic kidney disease
  • Serum PSA - prostatic enlargement
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10
Q

What is the management of a Pt presenting with upper urinary tract obstruction?

A 
1. Resuscitation
• ABCs
• IV access, bloods, ABG, urine + blood cultures 
• IV fluids
• Analgesia 
• +/- renal replacement therapy
  1. Investigations
  2. Emergency treatment of obstruction
  3. Definitive treatment of obstruction
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11
Q

What is the emergency treatment of upper urinary tract obstruction?

A
  • Percutaneous nephrostomy insertion

* Retrograde stent insertion

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12
Q

What is the definitive treatment of upper urinary tract obstruction?

A

Treating underlying cause
• Stone (ureteroscopy and laser lithotripsy)
• Ureteric tumour (radical nephron-ureterectomy)
• PUJ obstruction (laparoscopic pyeloplasty)

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13
Q

What is a nephrostomy?

A

A nephrostomy is an opening between the kidney and the skin. A nephrostomy tube is a thin plastic tube that is passed from the back, through the skin and then through the kidney. Its job is to temporarily drain the urine that is blocked.

  • Percutaneous puncture
  • Usually under LA + sedation
  • US or Xray guidance
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14
Q

What is the presentation of lower tract obstruction?

A
  • Lower urinary tract symptoms - including urinary incontinence
  • Acute urinary retention
  • Chronic urinary retention
  • Recurrent urinary tract infection and sepsis
  • Frank haematuria
  • Formation of bladder stones
  • Renal failure
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15
Q

What is the immediate management of lower urinary tract obstruction?

A

Catheterisation

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16
Q

What investigations are used for lower urinary tract obstruction?

A
  • Urinary dipstick
  • U+Es
  • Urea and creatinine
  • FBC - anaemia of chronic kidney disease
  • Serum PSA - prostatic enlargement
  • Renal ultrasound
  • Bladder scan
17
Q

What is the management plan for a Pt who presents with lower urinary tract obstruction?

A
  1. Resuscitation
  2. Investigations
  3. Emergency treatment
  4. Definitive treatment of obstruction
18
Q

What is the emergency treatment for lower urinary tract obstruction?

A
  • Urethral catheterisation

* Suprapubic catheterisation

19
Q

What is the definitive treatment of lower urinary tract obstruction?

A 
Treat underlying cause:
• BPE – TURP
• Urethral stricture – Optical urethrotomy
• Meatal stenosis – Meatal dilatation
• Phimosis – Circumcision
20
Q

What are the features of high pressure chronic retention?

A
  • Painless
  • Incontinent
  • Raised Cr
  • Bilateral hydronephrosis
21
Q

What are the to types of chronic retention?

A

High and low pressure

22
Q

What are the features of low pressure chronic retention?

A
  • Painless
  • Dry
  • Normal Cr
  • Normal kidneys
23
Q

What are the possible complications of lower urinary tract obstruction?

A

• Decompression haematuria
- Shearing of small vessels due to differing compliance of tissue layers (usually self-limiting)

• Post-obstructive diuresis

  • Greater 200ml/hr
  • Osmotic diuresis 2y to urea; ADH; altered tubular function
  • Na and H2O depletion

Urinary System (31 decks)

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