Urinary Tract Obstruction Flashcards
Types of urinary tract obstruction
Upper tract (i.e. supra-vesical) - PUJ - ureter - VUJ Lower tract (i.e. bladder outflow obstruction) - bladder neck - prostate - urethra - urethral meatus - foreskin e.g. phimosis
Causes of obstruction at the pelvi-ureteric junction (PUJ)
PUJ obstruction - physiological - crossing vessel Stone Ureteric tumour (TCC) Blood clot Fungal ball Lymph node tumour Abdominal mass tumour
Causes of ureteric obstruction
Stone Ureteric tumour (TCC) Scar tissue Blood clot Fungal ball Lymph nodes - tumour - retroperitoneal fibrosis Iatrogenic Abdominal/pelvic mass - tumour - pregnant uterus
Causes of vesico-ureteric junction obstruction
Stone Ureteric tumour Bladder tumour Cervical tumour Prostate cancer
Presentation of upper urinary tract obstruction
Pain Frank haematuria Symptoms of complications Palpable mass Microscopic haematuria
Complications of upper urinary tract obstruction
Infection and sepsis
Renal failure
What is the chance of death with an obstructed infected kidney?
1 in 5
Treatment of infected pyelonephritis and sepsis
Antibiotics
Fluid
Analgesics
Treatment of upper tract obstruction
Resuscitation Emergency treatment of obstruction (for unremitting pain or complications) - percutaneous nephrostomy insertion - retrograde stent insertion Treat underlying cause
How to treat a stone causing obstruction
Ureteroscopy and laser lithiotripsy +/- basketing or ESWL
How to treat a ureteric tumour
Radical nephron-ureterectomy
How to treat a PUJ obstruction
Laparoscopic pyeloplasty
Presentation of lower tract obstruction
LUTS - including incontinence Acute urinary retention Chronic urinary retention Recurrent UTI and sepsis Frank haematuria Formation of bladder stones Renal failure
Treatment of lower urinary tract obstruction
Resuscitation Emergency treatment of obstruction (if unremitting pain or complications) - urethral catheterisation - suprapubic catheterisation Treatment of obstruction
Investigations of lower urinary tract obstruction
Bladder scan
USS renal tract
How to treat BPE causing obstruction
TURP
How to treat a urethral stricture causing obstruction
Optical urethrotomy
How to treat metal stenosis causing obstruction
Meatal dilatation
How to treat phimosis causing obstruction
Circumcision
Presentation of high pressure chronic retention
Painless
Incontinent
Raised creatinine
Bilateral hydro-nephrosis
Presentation of low pressure chronic retention
Painless
Dry
Normal creatinine
Normal kidneys
Complications of lower tract obsctruction
Decompression haematuria
Post obstructive diuresis
What is decompression haematuria?
Shearing of small vessels due to differing compliance of tissue layers
