Urinary Tract Obstruction/Malignancy

Question 1

Any obstruction which occurs in the urinary tract can cause a back up of pressure to the kidneys. What complication can this cause?

Explain the difference in the position of the obstruction if it causes bilateral as opposed to unilateral kidney problems

Answer 1

Hydronephrosis - dilation of the collecting system

Unilateral = occurs in ureter
Bilateral = bladder or lower

Question 2

Stones rarely cause pain but if they do what is the pain like?

Answer 2

V painful Loin pain which comes and goes - ‘CLASSIC RENAL COLIC’

Haematuria

Question 3

What is the name of the cancer found in the urinary tract?

Answer 3

Transitional cell carcinoma - 2 forms =

• papillary
• Carcinoma in situ

Question 4

What is the lifestyle choice that vvv strongly increases your risk of transitional cell carcinoma?

Answer 4

Smoking

- almost as much a risk as lung cancer

Question 5

How would you present with urinary tract malignancy?

Answer 5

Haematuria

Question 6

If a patient is suffering from renal sepsis and severe hydronephrosis due to urinary tract obstruction. What should be done?

Answer 6

Percutaneous nephrostomy - immediate drainage of stagnant urine in kidneys

Question 7

What is the gold standard method of investigating renal stones?

Answer 7

CT KUB (kidneys ureter and bladder)

Question 8

What size is a kidney stone before it is unlikely to pass spontaneously?

What is first line after this point?

Answer 8

> 6mm unlikely to self resolve

1. nifedipine or tamsulosin - most expel after 48hrs with this
2. ESWL - US waves
3. Percutaneous nephrolithotomy - if large, complex or multiple

Question 9

What is the name for the calculus that can lead to big blockages in the kidneys?

What type of organism are they associated with?

Answer 9

Staghorn calculus

Proteus

Question 10

80% of urinary stones reoccur in 10 yrs. What advice can be given to patients to reduce this?

Answer 10

Increase H20 intake
Decrease Na+ intake
Adequate Ca+ intake

Question 11

What pain relief should initially be offered to patients?

Answer 11

NSAIDS

Question 12

In what situation is ESWL contra-indicated?

Answer 12

Obesity

Question 13

What site is most common for stones to get lodged?

Answer 13

Vesicoureteric junction

Question 14

What can happen once urinary tract obstruction is removed?

Answer 14

A period of salt-losing nephropathy

Hyponatremia
high Na+ in urine
Urine output normal