Urinary Obstruction**** Flashcards
What symptoms apart from retention does someone have with obstruction have?
Causes:
Name 3 intraluminal causes?
List some intramural (in the wall) causes?
Difficulty passing urine:
- Reduced flow
- Straining to void
- Hesitancy
- Dribbling
Stones
Clots
Foreign body
Tumour Polyps Stricture Neurogenic bladder Congenital urethral valves
Urinary obstruction:
Causes:
Extramural:
- What prostatic diseases could cause this? - 2
- What gynae diseases could cause this?
- What GI problem may cause this?
BPH
Cancer
Prolapse ‘cystocele, rectocele’
Ovarian cyst
Fibroids
Uterine cancer
Faecal impaction
Why may unilateral obstruction be silent?
Due to the other kidney functioning normally
Acute upper tract obstruction:
Where do they get pain?
Where does the pain radiate to?
What may be superimposed?
What may you notice on examination? - 2
Loin pain
Groin
Infection
Tenderness - infection
Enlarged kidney
Chronic upper tract obstruction:
They get flank pain. Where is this pain?
DON’T FORGET MALIGNANCY AS CAUSE
Flank pain refers to discomfort in your upper abdomen or back and sides. It develops in the area below the ribs and above the pelvis. Usually, the pain is worse on one side of your body.
Acute lower tract obstruction:
Where do they get pain?
What may also be present in the elderly?
What may you find on examination?
What about percussion?
Suprapubic pain
Confusion
Dull to percussion
Acute lower tract obstruction:
Causes:
- What is common in older male patients?
- What drug could cause this and why?
- What is clot retention?
- Why can alcohol cause it?
- What GI pathology may cause this?
- Why can it happen post-op?
- What neurological pathology may also cause this?
BPH
Anticholinergics - decreasing bladder detrusor muscle contraction.
Bloods clots from e.g. bladder lesion
Alcoholic neuropathy refers to any nerve damage as a result of excessive consumption of alcohol; alcoholic neuropathy commonly presents as numbness in the arms or legs. In this case, excessive alcohol use causes nerve damage in the bladder, which resulted in urinary retention and abdominal distension.
Constipation
Urinary retention is a common complication that arises after a patient has anaesthesia or surgery. The analgesic drugs often disrupt the neural circuitry that controls the nerves and muscles in the urination process.
Cauda equina syndrome
Chronic lower tract obstruction:
What symptoms will they have? - 5
Frequency
Hesitancy - If you have trouble starting to urinate or maintaining urine flow, you may have urinary hesitancy.
Poor stream
Terminal dribbling
Overflow incontinence - the involuntary release of urine—due to a weak bladder muscle or to blockage—when the bladder becomes overly full, even though the person feels no urge to urinate.
Chronic lower tract obstruction:
Complications:
- What infection is common?
- Why do they get renal failure?
Causes:
- Why is the most common cause in men?
- How does DM cause it?
- What CNS disease could cause it?
DON’T FORGET MALIGNANCY AS CAUSE
Bilateral obstructive uropathy
UTI
BPH
Due to neuropathy - the sphincter muscle’s control is damaged by diabetes, it can either fail to relax, causing urinary retention or fail to contract, causing the involuntary leakage of urine.
Transverse myelitis
MS
Investigations:
Bloods:
- U&E, Creatinine and FBC are always done. What can be done specifically for the prostate?
What imaging is used?
What imaging should be used if there is hydronephrosis or hydroureter (distention of the renal pelvis and calyces or ureter)?
What does radionuclide imaging do?
Prostate-specific antigen (PSA)
USS
CT - determines level of obstruction
Enables functional assessment of the kidneys
Management - Upper:
What 2 invasive procedures can be done?
A pyeloplasty is done for PUJ obstruction. What does PUJ stand for?
Nephrostomy
Ureteric stent
Pelviureteric junction
Management - Lower:
1 solution for this?
You basically treat the underlying cause!!!
Catheterise the patient
Ureteric stenting:
They cause a lot of discomfort for patients. What can be prescribed to reduce the pain?
Alpha-blockers
