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renal system > Urinary Tract Obstruction > Flashcards

Urinary Tract Obstruction Flashcards

1
Q

What types of obstruction can occur?

A

Upper tract (supra-vesicle)

  • PUJ
  • Ureter
  • VUJ

Lower tract (bladder outflow obstruction)

  • Bladder neck
  • Prostate
  • Urethra
  • Urethral meatus
  • Foreskin (phimosis)
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2
Q

What intrinsic causes of obstruction are there are the PUJ?

A
  • PUJ obstruction (physiological)
  • Stone
  • Ureteric tumour (TCC)
  • Blood clot
  • Fungal ball
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3
Q

What extrinsic causes of obstruction are there at the PUJ?

A
  • PUJ obstruction (crossing vessel)
  • Lymph nodes (tumour)
  • Abdominal mass (tumour)
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4
Q

What intrinsic causes of obstruction are there at the ureter?

A
  • Stone
  • Ureteric tumour (TCC)
  • Scar tissue
  • Blood clot
  • Fungal ball
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5
Q

What extrinsic causes of obstruction are there at the ureter?

A
  • Lymph nodes (tumour, retroperitoneal fibrosis)
  • Iatrogenic
  • Abdominal/pelvic mass (tumour, pregnant uterus)
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6
Q

What intrinsic causes of obstructions are there are at the VUJ?

A
  • Stone
  • Bladder tumour
  • Ureteric tumour
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7
Q

What extrinsic causes of obstructions are thee at the VUJ?

A
  • Cervical tumour

- Prostate cancer

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8
Q

How may someone with an upper tract obstruction present?

A

Symptoms

  • Pain
  • Frank haematuria
  • Symptoms of complications

Signs

  • Palpable mass
  • Microscopic haematuria
  • Signs of complications

Complications

  • Infection and sepsis
  • Renal failure
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9
Q

What resuscitation is important in the management of upper tract obstruction?

A
  • ABCs
  • IV access, bloods, ABG, urine and blood cultures, fluid balance monitoring
  • IV fluids, broad spectrum antibiotics (if appropriate)
  • Analgesia
  • HDU care +/- renal replacement therapy (if appropriate)
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10
Q

What emergency treatment can be carried out for upper tract obstruction?

A
  • Percutaneous nephrostomy insertion

- Retrograde stent insertion

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11
Q

What definitve treatment is there for upper tract obstruction?

A

Treat the underlying cause

  • Stone: urteroscopy and laser lithotripsy +/- basketing or ESWL
  • Ureteric tumour: radical nephron-ureterectomy
  • PUJ obstruction: laparoscopic pyeloplasty
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12
Q

How is nephrostomy carried out?

A

Percutaneous puncture usually under LA and sedation using US or x-ray guidance

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13
Q

What must you be careful of in nephrostomy procedures?

A
  • Bleeding

- Possible damage to adjacent organs

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14
Q

What type of ureteric stent are there?

A
  • Silicone
  • Polyurethane
  • Nickel titanium (usually for malignant obstruction)
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15
Q

How can lower urinary tract obstruction present?

A
  • Lower urinary tract symptoms (including urinary incontinence)
  • Acute urinary retention
  • Chronic urinary retention
  • Recurrent urinary tract infection and sepsis
  • Frank haematuria
  • Formation of bladder stones
  • Renal failure
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16
Q

How should catheterisation be carried out in urinary retention?

A
  • Immediately
  • Using urethral catheter 14/16F
  • Residual volume recorded
  • Take 2 attempts (then introducer if GA experience)
  • Use 16F SPC if urethra impassable
17
Q

What resuscitation is important in the management of lower tract obstruction?

A
  • ABCs
  • IV access, bloods, ABG, urine and blood cultures, fluid balance monitoring
  • IV fluids, broad-spectrum antibiotics (if appropriate)
  • Analgesia
  • HDU care +/- renal replacement therapy (if appropriate)
18
Q

What investigations can be carried out for lower tract obstruction?

A

Imaging

  • Bladder scan
  • USS renal tract
19
Q

What emergency treatment is there for lower tract obstruction?

A

-Urethral catheterisation
OR
-Suprapubic catheterisation

20
Q

What is the definitive treatment for lower tract obstruction?

A

Treat underlying cause

  • BPE: TURP
  • Urethral stricture: Optical urethrotomy
  • Meatal stenosis: meatal dilatation
  • Phimosis: circumcision
21
Q

What features of chronic retention should you worry about?

A
  • High pressure
  • Painless
  • Incontinent
  • Raised creatinine
  • Bilateral hydronephrosis
22
Q

What are the possible complications of lower tract obstruction leading to CUR?

A
  • Decompression haematuria

- Post obstructive diuresis

23
Q

Why does decompression haematuria occur?

A
  • Shearing of small vessels due to differing compliance of tissue layers
  • Usually self limiting
24
Q

When does post obstructive diuresis occur?

A
  • Greater than 150-200ml/hr

- 0.5-50%

25
Q

Why does post obstructive diuresis occur?

A

Osmotic diuresis 2y to urea; ADH; altered tubular function

26
Q

What can post obstructive diuresis lead to?

A

Can lead to life threatening sodium and water depletion

27
Q

How much fluid should someone with post obstructive diuresis receive?

A

Normal saline at input = output-30mlhr

renal system (26 decks)

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