Upper Tract Obstruction Flashcards
Intrinsic Causes of Upper Tract Obstruction at Pelvi-Ureteric Junction
PUJ Obstruction Stone Ureteric Tumour Blood Clot Fungal Ball
Intrinsic Causes of Upper Tract Obstruction at Ureter
Stone Ureteric Tumour Scar Clot Fungal Ball
Intrinsic Causes of Upper Tract Obstruction at Vesico-Ureteric Junction
Stone
Bladder Tumour
Prostate Cancer
Ureteric Tumour
Extrinsic Causes of Upper Tract Obstruction at Pelvi-Ureteric Junction
PUJ Obstruction Lymph Nodes (Tumour) Abdo Mass (tumour)
Extrinsic Causes of Upper Tract Obstruction at Ureter
Lymph Nodes (Tumour, Retroperitoneal Fibrosis)
Iatrogenic
Abdo/Pelvic Mass (Tumour)
Pregnant Uterus
Extrinsic Causes of Upper Tract Obstruction at Vesico-Ureteric junction
Cervical Tumour
Prostate Cancer
Symptoms and Signs of Upper Tract Obstruction
Pain
Frank Haematuria
Palpable Mass
Microscopic Haemturia
Management of Upper Tract Obstruction
Resusitation
Treat Cause
Emergency Treatment of Upper Tract Obstruction
Percutaneous Nephrostomy Insertion or Retrograde Insertion
How to Treat Stone in Obstruction
Ureteroscopy and Laser Lisotripsy
How to treat Ureteric Tumour in Obstruction
Radical Nephro-Ureterectomy
How to trat PUJ Obstrution in Obstruction
Laparoscopic Pyeloplasty
If urethra is impassible for cauterisation then use
16F SPC
Management Lower Tract Obstruction Emergency
Catherisation
Treating BPE in Obstruction
TURP
Treating Urethral Stricture in lower tract Obstruction
Optic Urethrotomy
Treating Meatal Stenosis in Lower Tract obstruction
Meatal Dilation
Treating Phimosis in Lower Tract obstruction
Circumcision
Chronic Retention High Pressure presents as
Painless
Incontinent
Raised CR
Bilateral Hydro Nephrosis
Chronic Retention Low Pressure presents as
Painless
Dry
Normal CR
Normal Kidneys
Complications of Urinary Retention
Decompression Haematuria
Post Obstructive Diuresis
What is decompression haematuria
shearing of small vessels
usually self limit
what is post obstructive diuresis
greater than 200ml
can lead to life threat sodium and water depletion
If upper tract is obstructed what will ultrasound show
Hydronephrosis and Hydroureter
What could Nuclear Isotope (Tech 99) scan determine
Split Renal Function (should be 50/50)
Used for Chronic Unilateral PUJ Obstruction
CT KUB Advantages
No risk of contrast nephrotoxicity
Can be used in renal failure
stones and obstruction in emergency
ct urogram contraindications
renal failure
gives out 15-20 radio
ct urogram advantages
can detect masses
gold standard for renal colic test
ct kub
