Urinary tract obstruction

Question 1

Causes of urinary tract obstruction?

Answer 1

Luminal: Stones, clots, sloughed papilla

Mural: Tumours, congenital/acquired strictures, neuromucular dysfunction

Extramural: Prostatic enlargement, abdominal/pelvic tumour, retroperitoneal fibrosis

Question 2

Presentation of urinary tract obstruction?

Answer 2

Acute: upper tract presentation is loin to groin pain.
Lower tract: BOO severe suprapubic pain with a distended, palpable bladder

Chronic: upper tract: flnak pain, renal failure
lower tract: LUTS, distended palpable bladder with maybe large prostate on PR

Question 3

Ix in urinary tract obstruction?

Answer 3

FBC, U+E
Urine dip, mcands
Imaging: US for hydronephrosis
Radionucleotide imaging can help image renal fx
CT/MRI

Question 4

Complications of ureteric stents?

Answer 4

Infection
haematuria
trigonal irritation
encrustation
obstruction
rupture
stent migration

Question 5

What can cause urethral strictures?

Answer 5

Trauma: instrumentation, pelvic #
Infections: gonnorhea
chemo
balanitis xerotica obliterans

Question 6

How do urethral strictures present?

Answer 6

Hesitancy, strangury, poor stream, terminal dribbling, pis en deux

Question 7

Examination of urethral stricture?

Answer 7

PR
Palpate urethra through penis
examine meatus

Question 8

Ix in urethral stricture?

Answer 8

urodynamics: show reduced peak flow and incr micturition time

Urethroscopy and cystoscopy
retrograde urogram

Question 9

Management of stricture?

Answer 9

Internal urethromomy
dilation
stent