Urinary tract obstruction

Question 1

Upper urinary tract obstruction involves everything above the bladder

Lower urinary tract obstruction involves what structures

Answer 1

bladder neck
prostate
urethra
foreskin

Question 2

Causes of upper urinary tract obstruction

• intrinsic (i.e. within the tract) (4)
• extrinsic (i.e. outwith the tract) (2)

Answer 2

Stone
Tumour - of ureter
Thrombus
Fungal ball

Enlarged lymph nodes
Abdo tumour

Question 3

Renal colic (loin/flank pain anywhere in urinary tract) is pain usually caused by what

Answer 3

a stone

Question 4

Symptoms (1) /signs (2) of upper urinary tract obstruction (could be due to stone, tumour, thrombus)

Answer 4

Symptoms
-pain (aka renal colic)

Signs

• palpable mass
• frank/microscopic haematuria

Question 5

Ureteric stones almost always originate in the

Answer 5

kidney

Question 6

What is renal colic

Answer 6

Acute and severe loin pain caused by a urinary stone

Question 7

Symptoms (4)/signs (1) of kidney (nephrolithiasis)

Answer 7

Renal colic - acute severe flank pain/lower back pain
Nausea/vomiting
Frequency
Urgency

Microscopic haematuria

Question 8

Gold standard investigation of kidney/ureteric stone

Answer 8

Non contrast CT abdo

Question 9

Severe kidney/ureteric stones that have spread infection to the blood may cause what systemic symptoms/signs

Answer 9

Fever
Tachycardia
Hypotension

Question 10

Principles of management of patients with renal pain and ureteric colic (i.e. upper urinary tract obstruction - due to stone or tumour or thrombus)

Answer 10

Resuscitation

• IV fluids if hypotensive
• Oxygen if low sats
• antibiotics if infection
• analgesia

Emergency treatment of upper obstruction

• nephrostomy (tube inserted through back to the kidney to drain fluid)
• or ureteric stent

Definitive treatment of obstruction (i.e. treat underlying cause)
-remove the kidney/ureteric stone or tumour

Question 11

Treatment of OBSTRUCTIVE kidney/ureteric stones

• initial medical (3)
• surgical decompression (2)
• surgical removal (2)

Answer 11

Hydration
Analgesia
Anti-emetics

Surgical decompression
-nephrostomy or ureteric stent

Surgical removal

• extracorporeal shock wave lithotripsy (ESWL) - more for kidney stone than ureteric
• ureteroscopy

Question 12

Different presentations of lower urinary tract obstruction

Answer 12

LUTS
Urinary retention - acute or chronic
Recurrent UTIs --> sepsis
Frank haematuria
Bladder stones
Renal failure

Question 13

Principles of management of lower urinary tract obstruction

• resuscitate (4)
• emergent treatment
• definitive treatment

Answer 13

Resuscitation

• IV fluids if hypotensive
• Oxygen if low sats
• antibiotics if infection
• analgesia

Emergency treatment of lower obstruction
-catheterisation

Definitive treatment of obstruction (i.e. treat underlying cause)
-treat the BPH or urethral stricture

Question 14

Investigations of lower urinary tract obstruction

Answer 14

Bladder scan

Renal tract USS

Question 15

Emergency treatment of lower urinary tract obstruction

Answer 15

catheterisation

Question 16

Emergency treatment of upper urinary tract obstruction

Answer 16

nephrostomy or ureteric stent - to drain the excess fluid

Question 17

Chronic urinary retention is either

Answer 17

high pressure or low pressure

Question 18

Differences between high (4) and low pressure chronic urinary retention (3)

Answer 18

High pressure

• Painless
• Incontinent
• Raised cr
• bilateral hydronephrosis

Low pressure

• painless
• Normal cr
• normal kidneys