Urinary tract obstruction Flashcards
Where might obstructing lesions lie in urinary tract obstruciton?
- Lumen
- Wall of the urinary tract
- Outside the wall of the urinary tract
What are causes of urnary obstruction within the lumen of the urinary tract?
- Calculi
- Blood clot
- Cloughed papilla
- Tumour - renal pelvis, ureter, bladder
What are causes of urinary tract obstruction that originate from in the wall of the lumen?
- Ureteric/Uterovesical stricture
- Congenital bladder neck obstruction
- Urethral stricture
- Congenital urethral valve
- Neuopathic bladder
What are causes of urinary obstruction that originate from outside the ureter?
- Tumours
- Diverticulitis
- Aortic aneurysm
- Retroperitoneal fibrosis
- Accidental ligation
- Retrocaval ureter
- Prostatic obstruction
- Phimosis
What is the pathophysiology of urinary tract obstruction?
Obstruction with continuing urine formation results in:
- Progressive rise in intraluminal pressure
- Dilatation proximal to the site of obstruction
- Compression and thinning of the renal parenchyma
What are features of acute upper urinary tract obstruction?
- Loin to groin pain
- Loin tenderness
- Signs of cause - superimposed infection/enlarged kidney
What are features of chronic upper urinary tract obstruction?
- Flank pain
- Renal failure
- Superimposed infection
- Can have polyuria
What are symptoms of acute urinary retention/acute lower tract obstruction?
- Severe suprapubic pain
- Acute confusion (elderly)
What are signs of acute urinary retention?
- Distended, palpable bladder
- Dull to percussion
What residual volumes might someone have if in acute urinary retention?
400ml - 2L
What are causes of acute urinary retention?
- Prostatic obstruction
- Urethral strictures
- Anticholinergics
- Blood clots
- Alcohol
- Contipation
- Post-op
- Infection
- Neurological
What are complications of chronic urinary retention?
- Overflow incontinence
- Renal failure
- UTI
What are symptoms of chronic urinary retention?
- Urinary frequency
- Hesitancy
- Poor stream
- Terminal dribbling
- Overflow incontinence
What a signs of chronic lower tract obstruction?
- Distended, palpable bladder
- May have nelarged prostate
What are causes of chronic urinary retention?
- Prostatic enlargement
- Pelvic malignancy
- Rectal surgery
- DM
- CNS disease - transverse myelitis, MS
- Zoster - S2-S4