Urology - obstructive uropathy

Question 1

Common causes of obstructive uropathy

Answer 1

Upper UT obstruction:

• Kidney stones
• Tumours compressing ureters
• Ureter strictures ( e.g. due to scar tissue narrowing it
• Retroperitoneal fibrosis (scar tissue in the retroperitoneal space)
• Bladder cancer (blocking the ureteral openings)
• Ureterocele (ballooning of the distal ureter – usually congenital)

Lower UT obstruction:

• BPH
• Prostate cancer
• Bladder cancer (blocking neck of bladder)
• Urethral strictures
• Neurogenic bladder

Question 2

What is a neurogenic bladder?

Answer 2

Neurogenic bladder refers to abnormal function of the nerves innervating the bladder and urethra.

It can result in overactivity or underactivity in the detrusor muscle of the bladder and the sphincter muscles of the urethra.

Question 3

Causes of neurogenic bladder

Answer 3

MS
Diabetes
Stroke 
PD
Brain or spinal cord injury
Spina bifida

Question 4

What problems can neurogenic bladder result in?

Answer 4

Urge incontinence
Increased bladder pressure
Obstructive uropathy

Question 5

Treatment of urinary obstruction

Answer 5

Urethral/suprapubic catheter to bypass obstruction in lower UT

A nephrostomy may be used to bypass an obstruction in the upper urinary tract (e.g., a ureteral stone)

Question 6

Complications of obstructive uropathy

Answer 6

Pain

AKI

Hydronephrosis/hydroureter

Infection (UTI)

Urinary incontinence

Question 7

What is the treatment of hydronephrosis?

Answer 7

Treat the underlying cause

If needed pressure can be relieved with either:

• Percutaneous nephrostomy
• Antegrade ureteric stent -inserting a stent through the kidney into the ureter - under radiological guidance