Urinary Tract Obstruction Flashcards
Congenital Urethral Obstructions
- Meatal Stenosis
- Phimosis
- Congenital Urethral stenosis (girls)
- Posterior urethral valves (boys)
Bladder Neck Obstruction causes
- BPH
- Primary obstruction/ muscle overgrowth
- Bladder neck contracture (post-op)
Trabeculation
Hypertrophy of bladder neck muscle due to INC urinary resistance f/ obstruction
End result of bladder neck urinary obstruction + trabeculation
- INC in Urgency + Freq of urine
- Formations of cellules -> Diverticulum
Morph changes hydronephrosis
- blunted/clubbing of renal calyx
- ischemic parenchymal injury; atrophy/scarring
CT Urogram hydronephrosis grades
Grade 1–loss of calyxeal waist
Grade 2– flattening of the calyx
Grade 3 ‐‐clubbing of calyx
Grade 4– ballooning of calyx
Use of Scans in Urine Obstruction
- CT: Test of choice;shows anatomy, hydronephrosis, tumor, or stones; NO contrast due to renal impairment
- MRI: anatomic; can image stones, but better for tumors
Nuclear renal scan: - Funcitonal test for comprosmised renal function - VCUG: Test Vesicourethral reflux/ post-void residual
What is used to visualize the posterior urethral valves?
Transurethral fulguration via cytoscope
BPH medical Treatment
- 5-a-Red Inh (finasteride, Avodart)
- alpha blockers (Flomaz/tamsulosin)
- PDE5 inh(cialis)
Pyeloplasty is used for
Uretopelvic junction obstruction
VUR in children
- Common in children, most resolve as the grow/develop
4 year old girl with four UTIs in past year.
Urinary frequency and dysuria noted.
Resolved each time with antibiotics sensitive to urine culture
What tests do you order?
UA, culture, and VCUG
Interstitial cystitis
- epi
- s/s
- A/S
- Diagnosis
- Tx
- women all ages
- s/s: dysuria, suprapubic pain, dyspareunia, nocturia
- A/S: IBS, fibromyalgia, chronic fatigue, endometrisosis, vulvodynia, anxiety
- Diagnosis of exclusion; sometimes Hunner’s Ulcer’s are present
- Tx: multi-modal: Pentosan polysulfate, tricyclics, duloxetine, antihistamines, anticholinergics, BZDs
