Urinary Tract Obstruction Flashcards
What are the different types of urinary tract obstruction?
- Upper tract (ie supra-vesical)
- Pelvi-ureteric junction (PUJ)
- Ureter
- Vesico-ureteric junction (VUJ)
- Lower tract (ie bladder outflow obstruction)
- Bladder neck
- Prostate
- Urethra
- Urethral meatus
- Foreskin (such as phimosis)
What is upper tract obstruction also known as?
Supra-vesical
What is lower tract obstruction also known as?
Bladder outflow obstruction
Where can upper urinary tract obstruction occur?
- Pelvi-ureteric junction (PUJ)
- Ureter
- Vesico-ureteric junction (VUJ)
Where can lower urinary tract obstruction occur?
- Bladder neck
- Prostate
- Urethra
- Urethral meatus
- Foreskin (such as phimosis)
What does PUJ stand for?
- Pelvi-ureteric junction (PUJ)
What does vesico-ureteric junction stand for?
- Vesico-ureteric junction (VUJ)
What are causes of PUJ obstruction?
What are causes of ureter obstruction?
What are causes of VUJ obstruction?
What are symptoms of upper tract obstruction?
- Pain
- Frank haematuria
- Symptoms of complications
What are signs of upper tract obstruction?
- Palpable mass
- Microscopic haematuria
- Signs of complications
What are complications of upper tract obstruction?
- Infection and sepsis
- Renal failure
What are the different classes of chronic upper tract obstruction?
High pressure or low pressure
Descibe the management of upper urinary tract obstriction?
Resuscitation:
- ABCs
- IV access, bloods, ABG, urine and blood cultures, fluid balance monitoring
- IV fluids, broad-spectrum antibiotics (if appropriate)
- Analgesia
- HDU care with or without renal replacement therapy (if appropriate)
Investigations including imaging
Emergency treatment for obstruction (for unremitting pain or complications):
- Percutaneous nephrostomy insertion or retrograde stent insertion
Definitive treatment for obstruction:
- Treat underlying cause
- If stone
- Ureteroscopy and laser lithotripsy with or without basketing or ESWL
- If ureteric tumour
- Radical nephron-ureterectomy
- If PUJ obstruction
- Laparoscopic pyeloplasty
- If stone
What treatment is involved in resuscitation?
- ABCs
- IV access, bloods, ABG, urine and blood cultures, fluid balance monitoring
- IV fluids, broad-spectrum antibiotics (if appropriate)
- Analgesia
- HDU care with or without renal replacement therapy (if appropriate)
What investigations are done for upper urinary tract obstruction?
Imaging
What is the emergency treatment for upper urinary tract obstriction?
- Percutaneous nephrostomy insertion or retrograde stent insertion
What is the definitive treatment for upper urinary tract obstruction?
- Treat underlying cause
- If stone
- Ureteroscopy and laser lithotripsy with or without basketing or ESWL
- If ureteric tumour
- Radical nephron-ureterectomy
- If PUJ obstruction
- Laparoscopic pyeloplasty
- If stone
What is a nephrostomy?
Is an opening between the kidney and the skin where a tube collects urine:
- Percutaneous puncture
- Watch for bleeding and adjacent organs
- Usually under local anaesthetic and sedation
- US or X-ray guided
What can ureteric stents be made from?
- Silicone
- Polyurethane
- Nickel titanium
What is the presentation of lower urinary tract obstruction?
- 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
Describe the management of lower urinary tract obstruction?
- Resuscitation
- 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)
- Investigations (including imaging: Bladder scan, USS renal tract)
- Emergency treatment of obstruction (for unremitting pain or complications)
- Urethral catheterisation OR
- Suprapubic catheterisation
- Definitive treatment of obstruction
- Treat underlying cause
- e.g. BPE – TURP
- e.g. Urethral stricture – Optical urethrotomy
- e.g. Meatal stenosis – Meatal dilatation
- e.g. Phimosis – Circumcision
What investigations are done for lower urinary tract obstruction?
Imaging (bladder scan, USS renal tract)
