Obstructive uropathy

Question 1

What is obstructive uropathy?

Answer 1

Blockage preventing urine flow through the ureters, bladder and urethra

Question 2

1) Name a way an upper urinary tract obstruction could present
2) Name a way a lower urinary tract obstruction could present

Answer 2

1) Loin to groin or flank pain on the affected side (stretching and irritation of ureter and kidney), reduced or no urine output, non-specific systemic symptoms i.e. vomiting, impaired renal function on blood tests
2) Difficulty or inability to pass urine, impaired renal function on blood tests, urinary retention

Question 3

1) Name an upper urinary tract cause of obstructive uropathy
2) Name a lower urinary tract cause of obstructive uropathy

Answer 3

1) Kidney stones, tumours pressing on the ureters, ureter strictures, retroperitoneal fibrosis, bladder cancer
2) BPA, prostate cancer, bladder cancer, urethral strictures, neurogenic bladder

Question 4

What is neurogenic bladder?

Answer 4

Abnormal function of the nerves innervating the bladder and urethra that can result in overactivity or underactivity in the detrusor muscle of the bladder and sphincter muscles of the urethra

Question 5

Name 2 causes of neurogenic bladder?

Answer 5

• Multiple sclerosis
• Diabetes
• Stroke
• Parkinson’s disease
• Brain or spinal cord injury
• Spina bifida

Question 6

Name a complication of neurogenic bladder?

Answer 6

• Urge incontinence
• Obstructive bladder
• Increased bladder pressure

Question 7

Management of obstructive uropathy involves removing or bypassing the obstruction - name a method of achieving this

Answer 7

• Nephrostomy
• Suprapubic or urethral catheter

Question 8

Name a complication of obstructive uropathy

Answer 8

• Pain
• AKI (post-renal)
• CKD
• Infection (from bacteria tracking up urinary tract into areas of stagnated urine)
• Hydronephrosis
• Urinary retention and bladder distention
• Overflow incontinence of urine

Question 9

What is hydronephrosis?

Answer 9

Swelling of the renal pelvis and calyces in the kidney which occurs due to obstruction of the urinary tract, leading to back-pressure into the kidneys

Question 10

If someone has a bladder outlet obstruction due to blood clots, how is it initially managed?

Answer 10

Bladder irrigation via 3 way urethral catheter