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8. Urology (Medical Knowledge) > Urinary Tract Obstruction > Flashcards

Urinary Tract Obstruction Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the different types of urinary tract obstruction?

A
  • 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)
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2
Q

What is upper tract obstruction also known as?

A

Supra-vesical

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3
Q

What is lower tract obstruction also known as?

A

Bladder outflow obstruction

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4
Q

Where can upper urinary tract obstruction occur?

A
  • Pelvi-ureteric junction (PUJ)
  • Ureter
  • Vesico-ureteric junction (VUJ)
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5
Q

Where can lower urinary tract obstruction occur?

A
  • Bladder neck
  • Prostate
  • Urethra
  • Urethral meatus
  • Foreskin (such as phimosis)
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6
Q

What does PUJ stand for?

A
  • Pelvi-ureteric junction (PUJ)
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7
Q

What does vesico-ureteric junction stand for?

A
  • Vesico-ureteric junction (VUJ)
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8
Q

What are causes of PUJ obstruction?

A
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9
Q

What are causes of ureter obstruction?

A
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10
Q

What are causes of VUJ obstruction?

A
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11
Q

What are symptoms of upper tract obstruction?

A
  • Pain
  • Frank haematuria
  • Symptoms of complications
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12
Q

What are signs of upper tract obstruction?

A
  • Palpable mass
  • Microscopic haematuria
  • Signs of complications
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13
Q

What are complications of upper tract obstruction?

A
  • Infection and sepsis
  • Renal failure
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14
Q

What are the different classes of chronic upper tract obstruction?

A

High pressure or low pressure

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15
Q

Descibe the management of upper urinary tract obstriction?

A

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
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16
Q

What treatment is involved in resuscitation?

A
  • 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)
17
Q

What investigations are done for upper urinary tract obstruction?

A

Imaging

18
Q

What is the emergency treatment for upper urinary tract obstriction?

A
  • Percutaneous nephrostomy insertion or retrograde stent insertion
19
Q

What is the definitive treatment for upper urinary tract obstruction?

A
  • 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
20
Q

What is a nephrostomy?

A

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
21
Q

What can ureteric stents be made from?

A
  • Silicone
  • Polyurethane
  • Nickel titanium
22
Q

What is the presentation of lower urinary tract obstruction?

A
  • 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
23
Q

Describe the management of lower urinary tract obstruction?

A
  • 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
24
Q

What investigations are done for lower urinary tract obstruction?

A

Imaging (bladder scan, USS renal tract)

25
Q

What is the emergency treatment for lower urinary tract obstruction?

A

Urethral catheterisation

OR

Suprapubic catheterisation

26
Q

What is the definitive treatment for lower urinary tract obstruction?

A
  • Treat underlying cause
  • e.g. BPE – TURP
  • e.g. Urethral stricture – Optical urethrotomy
  • e.g. Meatal stenosis – Meatal dilatation
  • e.g. Phimosis – Circumcision
27
Q

When is emergency treatent for obstruction required?

A

For unremitting pain or complications

28
Q

Compare the symptoms of high and low pressure chronic urinary retention?

A
  • High pressure
    • Painless
    • Incontinent
    • Raised creatinine
    • Bilateral hydro-nephrosis
  • Low pressure
    • Painless
    • Dry
    • Normal creatinine
    • Normal kidneys
29
Q

How does creatinine levels differ in high and low pressure chronic retenion?

A

High pressure - raised creatinine

Low pressure - normal creatinine

30
Q

What are complications of chronic urinary treatment?

A
  • 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

8. Urology (Medical Knowledge) (17 decks)

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