Urinary Tract Obstruction

Question 1

Urinary Tract Obstruction Points Susceptible to Obstruction

Answer 1

• Pelvi-ureteric junction (PUJ)
• At level of iliac vessels
• Vesico-ureteric junction (VUJ)
• Can be unilateral and bilateral

Question 2

Urinary Tract Obstruction Aetiology

Answer 2

Intraluminal
-Blood clot, calculi, sloughed papillae, tumour

Intramural

• Ureteric, urethral or ureterovesical stricture
• Congenital megaureter
• Bladder neck obstruction

Extramural

• PUJ compression from bands or aberrant vessels
• BPH
• Tumours
• Pancreatitis

Question 3

Urinary Tract Obstruction Epidemiology

Answer 3

• Occurs most commonly in young and old
• Common in older men due to BPH
• Hydronephrosis due to congenital abnormality is relatively common
• In women more commonly pelvic tumours, prolapse or pregnancy

Question 4

Urinary Tract Obstruction Presentation Acute Upper

Answer 4

• Flank pain
• Dull sharp or colicky
• Patient often restless and unable to lie still
• Often radiates

Question 5

Urinary Tract Obstruction Presentation Chronic

Answer 5

• Flank or abdominal pain

- Polyuria may be a feature

Question 6

Urinary Tract Obstruction Presentation Acute Lower

Answer 6

• Often follows chronic outflow obstruction
• Usually severe suprapubic pain
• Distended bladder

Question 7

Urinary Tract Obstruction Chronic Lower

Answer 7

-Hesitancy, weak stream, post-micturition dribble, incomplete emptying

Question 8

Urinary Tract Obstruction Investigations

Answer 8

• Urine dip
• USS then CT
• Bloods

Question 9

Urinary Tract Obstruction Management

Answer 9

• If stones <10mm they will pass spontaneously
• Alpha blockers may help
• If >10mm will need intervention
• Nephrostomy or stent
• Lithotripsy

If not due to calculi

• Stent is first choice
• Then nephrostomy