Ureteric Obstruction Flashcards
What are the causes of ureteric obstruction
Intraluminal - stones, sloughed papilla, clots
Intramural - pelvi-ureteric obstruction, upper tract cell carcinoma, benign strictures
Extraluminal - retroperitoneal malignancy, direct obstruction by tumour, retroperitoneal fibrosis
How does acute ureteric obstruction present and is it unilateral or bilateral
Present with renal colic pain which can radiate down to the groin
Pain may come and go or be continuous
Usually unilateral
How does chronic ureteric obstruction present and is it unilateral or bilateral
Chronic ureteric obstruction is usually painless -> presents as incidental finding, renal failure or as pyonephrosis
Typically bilateral
What is obstructive uropathy
Renal impairment due to: bilateral ureteric obstruction; unilateral ureteric obstruction of solitary kidney; high-pressure chronic retention
Usually cuased by post-renal injury
Usually causes increased K
What is pyonephrosis and how is it treated
Pyonephrosis - infection of the kidney collecting systems
Is a urological emergency with failure to decompress leading to death from sepsis or permanent loss of renal function
Treat with fluid, IV antibiotics -> senior urologist will decompress kidney
How is an upper tract obstruction diagnosed
CT and USS show structural changes and may show cause of obstruction
Diuretic renography - functional test where trace is injected which is filtered by kidney. If trace accumulates in pelvis, shows there is an obstruction
How is the kidney drained if there is an obstruction of the upper urinary tract
JJ stent - facilitates urine drainage through the bladder
Nephrostomy - tube inserted into kidney thorugh the abdomen and urine is drained into a bag
What is pelviureteric obstruction and how does it present
Pelviureteric obstruction is a congential condition which causes dilatation of the renal pelvis and calcyes due to obstruction of the PUJ
Can present with any stage of life
Can be asymptomatic -> incidental finding on imaging
Classical presentation: loin pain which is worse after drinking alcohol or after heavy fluid intake as these increase fluid production
What is retroperitoneal fibrosis, what is it caused by and how is it treated
Fibrotic tissue develops in retroperitoneum which covers the ureters and interferes with peristalsis of ureters causing obstruction
Causes: idiopathic, malignant, auto-immune, drugs, AAA
Treatment: decompression, exclusion of malignancy, steriods/immunosuppresion, ureterolysis
What are the symptoms of acute urinary retention and how is it treated
Symptoms: painful, inability to void. Large full bladder
Treatment:
- Catheterise and record residual volume -> do history, examination and urine dip
- Treat obvious causes
- Give alpha blocker in men to relax smooth muscle in prostate
- Trial without catheter for 1-2wks on alpha blocker to see if patient passes urine - if blocker fails, trim away prostate
What are the types of chronic urinary retention and what are the symptoms
High pressure - back pressure on the kidneys resulting in kidney failure. Have abnormal U&Es and hydronephrosis
Low pressure - patient has floppy bladder so no increase in ureteric pressure. Normal U&Es and no hydronephrosis
Symptoms: painless. May still void. 300-400ml residual volume
What is the treatment for chronic urinary retention
Catheterise and record residual volume
Perform history, examination and urine dip
Monitor patient for post-obstructive diuresis
What are the causes of urinary retention
Benign prostate hyperplasia
Prostate cancer
UTI
Constipation
Neurological dysfunction
Recent surgery
Drugs
Urethral strictures
Pelvic masses
What are urinary calculi most commonly formed of and what are the three most common sites which they occur at
Most commonly formed of Ca
Common sites are: uteropelvic junction, as ureter crosses pelvic brim, vesicoureteric junction
What are the types of urinary calculi
Kidney stones are either staghorn (fill numerous major and minor calyces) or non-staghorn (calyceal or pelvic)
Ureteral stones are either proximal middle or distal
Are also found in urinary bladder
