Urinary Tract Obstruction Flashcards
What are some intraluminal causes of uretetic obstruction?
Stones
Sloughed papilla
Clots
What are some intramural causes of uretetic obstruction?
Pelvic-ureteric junction obstruction (PUJO) - congenital Upper tract transitional cell carcinoma (TCC) Benign strictures (Tb, surgery)
What are some extrinsic causes of uriteric obstruction?
Extraluminal: Retroperitoneal malignancy
Direct obstruction by a tumour - bladder or locally advanced prostate cancer
Retroperitoneal fibrosis
How would ureteric obstruction present acutely?
“Renal colic” - caused by a calculus, but can be blood clots or sloughed papilla
Usually (not always) a unilateral problem
If there is super-added infection “pyonephrosis” -also feverish and unwell.
How would ureteric obstruction present chronically?
Generally painless (except PUJ obstruction)
Can be unilateral or bilateral but more commonly bilateral
Clinical presentations:
Incidental finding on imaging
Renal failure (obstructive uropathy)
Pyonephrosis
What causes renal impairment?
Bilateral ureteric obstruction (other kidney would compensate if not)
Unilateral ureteric obstruction where where is only one kidney
Also high pressure chronic retention
What is pyonephrosis and how do you manage it?
The infected, obstructed kidney- a urological emergency
Failure to promptly decompress may lead to death from sepsis, or permanent loss of renal function.
Initial management as per any septic patient but involve a senior urologist early.
Not obstructive causes of hydronephrosis?
Vesicoureteral reflux (VUR),- often picked up by paediatrics
Also pregnancy as gravid uterus presses on it and progesterone so kidneys become more compliant and dilate.
What is a diuretic renogram?
Used to confirm if obstructed kidney is working. It is a function test of kidney function.
Use a gamma camera take pictures of the kidney as tracer is absorbed.
Patient also give diuretic so tracer can accelerate.
If obstruction, count will go up and up (diuretic will make it worse) as it won’t be about to leave.
What is pelvicureteric junction obstruction?
Congenital condition
Can present with antenatal hydronephrosis on USS
May present at any stage in life
Can be symptomatic
Classically presentation: loin pain, worse after heavy fluid intake or alcohol -as pain intermittent.
Do diuretic renogram to check what it is.
Definitive treatment is pyeloplasty (laparoscopic)
What is retroperitoneal fibrosis and howdy you treat it?
Rare.
When patient develops fibrosis / scaring in retroperitoneum. Ureters become more medial and down into fibrosis which affects the way they peristalse.
Decompression, exclusion of malignancy (biopsy), steroids / immunosuppression or ureterolysis.
Causes of retroperitoneal fibrosis?
Idiopathic Malignancy (breasts, lung, stomach, lymphoma..) Auto-immune Drugs AAA
What is acute urinary retention?
Painful inability to void.
Residual volume 300-1500ml.
What is chronic urinary retention?
Can be high or low pressure
Painless
My still be voiding
Residual volume 300-400ml
Incidental finding or, if high pressure, renal failure
What are causes of urinary retention?
BPH (men) Prostate cancer (men) UTI Constipation Neurological dysfunction Recent surgery -prolonged anaesthetic Drugs - opiates for pain Urethral strictures / stenosis Pelvic masses (women) -fibroid uterus, ovarian cancer
