Urinary Obstruction

Question 1

where are three locations where obstruction can occur to cause urinary tract obstruction ?

Answer 1

luminal
mural
extramural

Question 2

state some mural causes of obstruction?

Answer 2

stricture (congenital/acquired)
tumour
neuromuscular dysfunction

Question 3

state some extramural causes of obstruction?

Answer 3

prostatic enlargement
tumour
retroperitoneal fibrosis

Question 4

state some symptoms of chronic urinary obstruction ?

Answer 4

flank pain 
renal failure (hydronephrosis)
voiding symptoms - frequency, dribbling, poor stream, hesitancy, overflow incontinence

Question 5

what could be assessed on a patient with urinary obstruction ?

Answer 5

mass in loin
palpable distended bladder
large prostate on PR exam

Question 6

waht imaging could be done for obstruction?

Answer 6

US - hydronephrosis
CT/MRI
radionucleotide imaging - for renal function
retrograde/ anterograde ureterogram

Question 7

what are three management options for urinary obstruction?

Answer 7

nephrostomy
ureteric stent
urethral catheter

Question 8

state some complications of ueteric stents?

Answer 8

Infection
 Haematuria
 Trigonal irritation
 Encrustation

Question 9

state some causes of urethral strictures?

Answer 9

Trauma
 Instrumentation
 Pelvic #s
 Infection: e.g. gonorrhoea
 Chemotherapy
 Balantitis xerotica obliterans

Question 10

what infection can cause narrowing of the urethral

Answer 10

gonorrhoea

Question 11

what is Balantitis xerotica obliterans

Answer 11

chronic, progressive, sclerosing inflammatory dermatosis of unclear etiology.

Question 12

state some voiding symptoms ?

Answer 12

terminal dribbling 
poor stream
hesitancy
strangury  
pis en deux

Question 13

what is pis en deux?

Answer 13

a desire to pass urine shortly after finishing voiding

Question 14

what three things should be examined for urethral stricture?

Answer 14

prostate
feel urethra through penis
examine meatus

Question 15

what three investigations should be done for urethral stenosis?

Answer 15

Urodynamics
 ↓ peak flow rate
 ↑ micturition time
 Urethroscopy and cystoscopy
 Retrograde urethrogram

Question 16

what is post obstructive diuresis?

Answer 16

 Kidneys produce a lot of urine in the acute phase
after relief of obstruction.
 Must keep up c¯ losses to avoid dehydration.

Question 17

state some complications of obstructive uropathy ?

Answer 17

hyperkalaemia 
metabolic acidosis 
post obstructive diuresis 
infection
hyponatreamia due to diuresis post obstruction