UTO

Question 1

What causes upper tract UTOs?

Answer 1

Transitional cell carcinoma tumours
Stones
Blood clots
Scar tissue at pelvic-ureteric-junction 
Abdo/pelvic mass

Question 2

What causes lower tract UTOs?

Answer 2

BPH
Bladder stones
Phimosis
Urethral strictures

Question 3

Upper UTO presentation?

Answer 3

Pain in the flank or loin
Haematuria (Frank or Micro)
Palpable mass maybe

Question 4

Complications of upper UTOs?

Answer 4

Infection and sepsis

Renal failure

Question 5

Initial management for obstructions?

Answer 5

Fluids
Bloods, ABGs & cultures
Analgesia
Broad Spec antibiotics if signs of infection

Question 6

UTO investigations?

Answer 6

Ultrasounds

CT-KUB (kidney, ureters and bladder)

Question 7

UTO management?

Answer 7

Initial management

Emergency bypass of the obstruction using percutaneous nephrostomy or a retrograde stent

More specific treatment depends on the cause

Question 8

Treatment for a stone?

Answer 8

Ureteroscopy and laser lithotripsy

Question 9

Treatment for a transitional cell carcinoma in upper tract?

Answer 9

Nephro-ureter-ectomy

Question 10

How do you treat an obstruction at the PUJ?

Answer 10

Laparscopic Pyeloplasty

Question 11

Lower UTO investigations?

Answer 11

• Bladder Scan
• Ultrasound renal tract
• Cystoscopy
• Digital Rectal Exam
• Urine Flow rate study

Question 12

How do manage a lower urinary tract obstruction?

Answer 12

Initial management as mentioned earlier

Emergency management with a catheter to relieve pain etc.

Then treat the cause

Question 13

How do you treat a urethral stricture?

Answer 13

Optical Urethotomy

Question 14

What is meatal stenosis and how do we treat it?

Answer 14

It is a urethral stricture at the external meatus

Meatal dilatation

Question 15

How do you treat phimosis?

Answer 15

Circumcision