Urinary Tract Obstruction

Question 1

Give 3 causes for intraluminal ureteric obstruction.

Answer 1

Sloughed papillae
Stones
Clots forming in the ureter

Question 2

Give 3 causes of intramural urinary tract obstruction.

Answer 2

PUJO
Benign strictures (GU TB and surgery)
Upper tract TCC

Question 3

Give 4 causes of extrinsic urinary Tract Obstruction.

Answer 3

Malignancy in retroperitoneum (lymph node metastasis)
VUJ obstruction due bladder cancer
Locally advanced prostate cancer
Retroperitoneal fibrosis

Question 4

What is an expection to the pain pattern in chronic ureteric obstruction?

Answer 4

Usually painless unless PUJO in which case intermittent and usually bilateral

Loin pain

Question 5

Give 3 causes of chronic ureteric obstruction.

Answer 5

PUJO
Lymph node metastasis
Retroperitoneal fibrosis

Question 6

Give 2 causes of hydronephrosis without obstruction.

Answer 6

VUR

Pregnancy

Question 7

What functional test can be done for diagnosis of upper tract obstruction?

Answer 7

Diuretic renography

Question 8

What is the surgical Tx for PUJO?

Answer 8

Pyeloplasty

Question 9

Name 2 surgical procedures to treat retroperitoneal fibrosis.

If the cause is auto-immune what should Tx be?

Answer 9

Ureterolysis
Decompression stenting

Steroid and immune suppression

Question 10

Give some causes of intravesicle obstruction that can affect both genders.

Answer 10

UTIs
Constipation
Cauda equina syndrome 
Recent surgery 
Prolonged GA usage 
Drugs - opioids

Question 11

What is the medical and surgical Tx for acute retention?

Answer 11

Medical - alpha blocker - relaxed prostate smooth muscle

TURP

Question 12

What should you be cautious off after treating chornic retention?

Answer 12

Post-obstructive diuresis

Initally physiolohical but can become pathological and lead to dehydration and electrolytes imbalance