FN: Urinary Tract Obstruction

Question 1

Causes

Answer 1

Luminal
Mural
Extramural

Question 2

Luminal

Answer 2

Stones
Blood clots
Sloughed papilla

Question 3

Mural

Answer 3

Congenital/acquired stricture
Tumour: renal, ureteric, bladder
Neuromuscular dysfunction

Question 4

Extramural

Answer 4

Prostatic enlargemnt
Abdo/pelvis mass/ tumou
Retroperitoneal

Question 5

Presentation acute

Answer 5

Upper Urinary tract - loin to groin pain
Lower tract: Frequency, hesitancy, poor stream, terminal dribbling, overflow incontinence
Distended, palpable bladder ± large prostate PR

Question 6

Chronic presentation

Answer 6

Upper: Flank pain, renal failure
Lower:
- frequnecy, hesitancy, poor stream, terminal dribbling, overflow incontinence
- Distended, palpable bladder ± large prostate PR

Question 7

Investigations

Answer 7

Bloods: FBC, U+E
Urine: dip, MC+S
Imaging:
-US: hydronephrosis or hydroureter
- Anterograde/retrpgrade ureterograms - allow therapeutic drainage
- Radionucleotide imaging: renal function
CT/MRI

Question 8

Management upper tract

Answer 8

Nephrostomy

Ureteric stent

Question 9

Mx ower

Answer 9

Urethral or supra pubic catheter - may be a large post-obstructive diuresis

Question 10

Complications of Stents common

Answer 10

infection
Haematuria
Trigonal irritation
Encrustation

Question 11

Rare complications of stents

Answer 11

Obstruction
Ureteric rupture
Stent migration