Urology - Urinary Tract Obstruction Flashcards
1
Q
Causes: luminal
A
- Stones
- blood clots
- sloughed papilla
2
Q
Causes: mural
A
- Congenital/acquired stricture
- Tumour: renal, ureteric or bladder
- Neuromuscular dysfunction
3
Q
Causes: extramural
A
- Prostatic enlargement
- Abdo/pelvic mass/tumour
- Retroperitoneal fibrosis
- AAA
4
Q
Urinary Tract Obstruction Presentation: acute
A
- Upper urinary tract: loin to groin pain
- Lower urinary tract: bladder outflow obstruction precedes severe suprapubic pain with distended palpable bladder
5
Q
Urinary Tract Obstruction Presentation: chronic
A
- Upper urinary tract: flank pain, renal failure (may be polyuric)
- Lower urinary tract: frequency, hesitancy, poor stream, terminal dribbling, overflow incontinence, distended/palpable bladder +/- big prostate on PR
6
Q
Urinary Tract Obstruction: Ix
A
- Bloods: FBC, U&E
- Urine dip: dip, MC + S
- Imaging: US (hydronephrosis or hydroureter), anterograde/retrograde ureterograms (allow therapeutic drainage), CT/MRI, radionucleotide imaging
7
Q
Urinary Tract Obstruction: Mx
A
- Upper urinary tract: nephrostomy or ureteric stent
- Lower urinary tract: urethral or suprapubic catheter (may be a large post-obstructive diuresis)
8
Q
Complications of ureteric stents (common and rare)
A
- Common: infection, haematuria, trigonal irritation, encrustations
- Rare: obstruction, ureteric rupture, stent migration
9
Q
Urethral stricture: aetiology
A
- Trauma
- infection (eg gonorrhea)
- chemotherapy
- Balanitis xerotica obliterans
10
Q
Urethral stricture: presentation - voiding difficulty
A
-Hesitancy, poor stream, Pis en deux, terminal dribbling
11
Q
Urethral stricture: Examination - what should you look out for?
A
- Pr: exclude prostatic cause
- Palpate urethra through penis
- Examine meatus
12
Q
Urethral stricture: Ix
A
- Urine dip
- Urodynamics (decreased peak flow rate and increased mircturition time)
- Urethroscopy and cystoscopy
- Retrograde urethrogram
13
Q
Urethral stricture: Mx
A
- internal urethrotomy
- Dilatation
- Stent
