Urinary Tract Obstruction Flashcards
What locations of the upper urinary tract are potential sites for obstruction?
Pelvi-ureteric junction (PUJ)
Ureter
Vesico-ureteric junction (VUJ)
What locations of the lower urinary tract are potential sites for obstruction?
Bladder neck Prostate Urethra Urethral meatus Foreskin
What are the intrinsic causes of obstruction at the PUJ?
PUJ obstruction due to scar tissue Stone Ureteric tumour Blood clot Fungal ball
What are the extrinsic causes of obstruction at the PUJ?
PUJ obstruction due to crossing vessel
Lymph node enlargement
Abdominal mass
What are the intrinsic causes of obstruction of the ureter?
Stone Ureteric tumour Scar tissue Blood clot Fungal ball
What are the extrinsic causes of obstruction of the ureter?
Lymph nodes e.g. tumour, retroperitoneal fibrosis
Iatrogenic
Abdominal/pelvic mass
What are the intrinsic causes of obstruction at the VUJ?
Stone
Bladder tumour
Ureteric tumour
Prostate cancer
What are the symptoms of upper urinary tract obstruction?
Pain
Frank haematuria
Symptoms of complications
What are the signs of upper urinary tract obstruction?
Palpable mass
Microscopic haematuria
Signs of complications
What are the complications of upper urinary tract obstruction?
Infection and sepsis
Renal failure
What is the management of upper urinary tract obstruction?
Resuscitation
Investigations
Emergency treatment of obstruction followed by definitive treatment of obstruction
What are the steps involved in resuscitation of a patient with urinary tract obstruction?
ABCs
IV access
Bloods, ABG, urine and blood cultures, fluid balance monitoring
IV fluids, broad-spectrum antibiotics if appropriate
Analgesia
HDU +/- RRT if appropriate
What is the emergency treatment of upper urinary tract obstruction?
Percutaneous nephrostomy insertion or retrograde stent insertion for unremitting pain or complications
What is the definitive treatment of upper urinary tract obstruction?
Treat underlying cause
e. g. stone - ureteroscopy and laser lithotripsy +/- basketing or ESWL
e. g. ureteric tumour - radical nephro-ureterectomy
e. g. PUJ obstruction - laparoscopic pyeloplasty
What is the presentation of lower urinary tract obstruction?
LUTS symptoms, including urinary incontinence Acute or chronic urinary retention Recurrent UTI Sepsis Frank haematuria Formation of bladder stones Renal failure
