Urology: Obstructive Uropathy Flashcards
Briefly outline the pathophysiology of obstructive uropathy
Blockage of the flow of urine out of the body
Outline the aetiology of obstructive uropathy.
Calculi
Urethral atresia
Phimosis
Meatal stenosis
Anterior and posterior urethral valves (males)
Blood clot
STD
BPH
Cancer of prostate or bladder
Carcinoma of cervix or colon
Neurogenic bladder (DM, spinal cord disease, multiple sclerosis, Parkinson’s, anticholinergic drugs, alpha-adrenergic antagonists, Ca channel blockers, opioids, sedative-hypnotics)
What are the signs and symptoms of obstructive uropathy?
Pain (most common symptom in acute obstruction but typically absent with slowly obstructing conditions)
Altered patterns of micturition
Acute and chronic renal failure
Gross or microscopic haematuria
Recurrent urinary tract infection (UTI)
New-onset or poorly controlled HTN secondary to obstruction and increased renin-angiotensin
Polycythemia secondary to increased EPO production in the hydronephrotic kidney
History of recent gynaecologic or abdominal surgery
How would obstructive uropathy be investigated?
Evaluation for dehydration and intravascular volume depletion; peripheral oedema, HTN, and signs of congestive HF from fluid overload may be observed in obstruction from renal failure
Palpable kidney or bladder (indicative of a dilated urinary collection system)
Rectal or pelvic exam = determine if enlargement of pelvic organs is a possible source of urinary obstruction
Exam of external urethra for phimosis or meatal stenosis
Urinalysis
Bloods = FBC, U+Es, BUN, albumin
CT KUB
MRI
IVP = IV pyelography
US
How would you manage obstructive uropathy?
Catheter = try to restore urinary flow
Small calculi = pass spontaneously
Percutaneous nephrostomy drainage = midureteral stones
Cystoscopical loop or basket = distal ureter stone
Extracorporeal shock wave lithotripsy = stone breakdown
BPH = medical management
What are the complications of obstructive uropathy?
Acute renal failure
Chronic renal failure
