Urinary Tract Obstruction

Question 1

Can be bilateral or unilateral. If unilateral - how do they present/

Answer 1

silent presentation and the patient can pass urine normally without symptoms.

Question 2

Presentation?

Acute upper ?
Chronic upper?

acute lower?
chronic lower?

Answer 2

acute upper:
colicky loin to groin pain, loin tenderness

chronic upper:
flank/loin pain, CKD +/- infection

acute lower:
severe suprapubic pain, distended bladder

chronic lower:
distended bladder. overflow incontinence, poor stream

Question 3

Initial ix?

Mx:

Upper
Lower

Answer 3

history, examination, DRE
Urine dip
Cultures – If suspecting infection
PSA – If suspecting BPH/ Pr Ca

Treat underlying cause!
Upper – Nephrostomy or ureteric stent
Lower – Urethral or suprapubic catheter

Question 4

what is acute lower obstruction usually due to?

and chronic lower?

Answer 4

Usually prostatic obstruction in men.

Prostate enlargement usually.

Question 5

what may help with ureteric stent pain in tx of upper obstruction

Answer 5

alpha blockers