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