Urinary Tract Obstruction Flashcards
What are the different types of urinary tract obstruction?
- Upper tract (ie supra-vesical)
- Pelvi-ureteric junction (PUJ)
- Ureter
- Vesico-ureteric junction (VUJ)
- Lower tract (ie bladder outflow obstruction)
- Bladder neck
- Prostate
- Urethra
- Urethral meatus
- Foreskin (such as phimosis)
What is upper tract obstruction also known as?
Supra-vesical
What is lower tract obstruction also known as?
Bladder outflow obstruction
Where can upper urinary tract obstruction occur?
- Pelvi-ureteric junction (PUJ)
- Ureter
- Vesico-ureteric junction (VUJ)
Where can lower urinary tract obstruction occur?
- Bladder neck
- Prostate
- Urethra
- Urethral meatus
- Foreskin (such as phimosis)
What does PUJ stand for?
- Pelvi-ureteric junction (PUJ)
What does vesico-ureteric junction stand for?
- Vesico-ureteric junction (VUJ)
What are causes of PUJ obstruction?
What are causes of ureter obstruction?
What are causes of VUJ obstruction?
What are symptoms of upper tract obstruction?
- Pain
- Frank haematuria
- Symptoms of complications
What are signs of upper tract obstruction?
- Palpable mass
- Microscopic haematuria
- Signs of complications
What are complications of upper tract obstruction?
- Infection and sepsis
- Renal failure
What are the different classes of chronic upper tract obstruction?
High pressure or low pressure
Descibe the management of upper urinary tract obstriction?
Resuscitation:
- ABCs
- IV access, bloods, ABG, urine and blood cultures, fluid balance monitoring
- IV fluids, broad-spectrum antibiotics (if appropriate)
- Analgesia
- HDU care with or without renal replacement therapy (if appropriate)
Investigations including imaging
Emergency treatment for obstruction (for unremitting pain or complications):
- Percutaneous nephrostomy insertion or retrograde stent insertion
Definitive treatment for obstruction:
- Treat underlying cause
- If stone
- Ureteroscopy and laser lithotripsy with or without basketing or ESWL
- If ureteric tumour
- Radical nephron-ureterectomy
- If PUJ obstruction
- Laparoscopic pyeloplasty
- If stone
What treatment is involved in resuscitation?
- ABCs
- IV access, bloods, ABG, urine and blood cultures, fluid balance monitoring
- IV fluids, broad-spectrum antibiotics (if appropriate)
- Analgesia
- HDU care with or without renal replacement therapy (if appropriate)
What investigations are done for upper urinary tract obstruction?
Imaging
What is the emergency treatment for upper urinary tract obstriction?
- Percutaneous nephrostomy insertion or retrograde stent insertion
What is the definitive treatment for upper urinary tract obstruction?
- Treat underlying cause
- If stone
- Ureteroscopy and laser lithotripsy with or without basketing or ESWL
- If ureteric tumour
- Radical nephron-ureterectomy
- If PUJ obstruction
- Laparoscopic pyeloplasty
- If stone
What is a nephrostomy?
Is an opening between the kidney and the skin where a tube collects urine:
- Percutaneous puncture
- Watch for bleeding and adjacent organs
- Usually under local anaesthetic and sedation
- US or X-ray guided
What can ureteric stents be made from?
- Silicone
- Polyurethane
- Nickel titanium
What is the presentation of lower urinary tract obstruction?
- Lower urinary tract symptoms
- Including urinary incontinence
- Acute urinary retention
- Chronic urinary retention
- Recurrent urinary tract infection and sepsis
- Frank haematuria
- Formation of bladder stones
- Renal failure
Describe the management of lower urinary tract obstruction?
- Resuscitation
- ABCs
- IV access, bloods, ABG, urine and blood cultures, fluid balance monitoring
- IV fluids, broad-spectrum antibiotics (if appropriate)
- Analgesia
- HDU care +/- renal replacement therapy (if appropriate)
- Investigations (including imaging: Bladder scan, USS renal tract)
- Emergency treatment of obstruction (for unremitting pain or complications)
- Urethral catheterisation OR
- Suprapubic catheterisation
- Definitive treatment of obstruction
- Treat underlying cause
- e.g. BPE – TURP
- e.g. Urethral stricture – Optical urethrotomy
- e.g. Meatal stenosis – Meatal dilatation
- e.g. Phimosis – Circumcision
What investigations are done for lower urinary tract obstruction?
Imaging (bladder scan, USS renal tract)
What is the emergency treatment for lower urinary tract obstruction?
Urethral catheterisation
OR
Suprapubic catheterisation
What is the definitive treatment for lower urinary tract obstruction?
- Treat underlying cause
- e.g. BPE – TURP
- e.g. Urethral stricture – Optical urethrotomy
- e.g. Meatal stenosis – Meatal dilatation
- e.g. Phimosis – Circumcision
When is emergency treatent for obstruction required?
For unremitting pain or complications
Compare the symptoms of high and low pressure chronic urinary retention?
- High pressure
- Painless
- Incontinent
- Raised creatinine
- Bilateral hydro-nephrosis
- Low pressure
- Painless
- Dry
- Normal creatinine
- Normal kidneys
How does creatinine levels differ in high and low pressure chronic retenion?
High pressure - raised creatinine
Low pressure - normal creatinine
What are complications of chronic urinary treatment?
- Decompression haematuria
- Shearing of small vessels due to difference compliance of tissue layers
- Usually self-limiting
- Post obstructive diuresis
- Greater than 200ml/hour
- Can lead to life threatening sodium and water depletion
