Urinary tract obstruction

Question 1

Define Urinary tract obstruction

Answer 1

it is defined as any obstruction (partial or complete) from the kidney to the urethral meatus (exit out of body)

20-30yrs M3:F1

If both kidneys are obstructed it will cause post-renal failure

Question 2

Describe the anatomy of the urinary system

Answer 2

start with renal pelvis then ureters which open into the bladder through the (ureteral orifice) then urethra then out of body

Question 3

3 commonest sites of Urinary tract obstruction?

Answer 3

Renal pelvis - commonest site

Uretropelvic junction - opening from pelvis to ureter

pelvic brim

Vesicoureteric junction (VUJ)

Question 4

a 32 year old male presents with left loin left upper quadrant pain radiating to the groin and not jaundiced

What is this and why?

Answer 4

This is urinary tract obstruction

Why? because it is left sided loin and upper quadrant pain, and not jaundiced, so not billary.

he is male so most likely obstruction rather than pyelonephritis

may become pyelonephritis if not treated.

Question 5

How can urinary tract obstruction present

Answer 5

renal colic - sudden pain in the loin radiating to the groin, testis or labium.

severity increases within minutes to reach peak in few minutes, may cause patient to groan in agony

often vomiting and cannot lie still (differentiate from peritonitis)

Question 6

what investigations in urinary tract obstruction

Answer 6

FBC

U&Es - Ca and PO

Urine dipstick –> +ve for blood

MSU MC&S

spiral non-contrast CTKUB best

Question 7

a 32 year old male presents with left loin left upper quadrant pain radiating to the groin and not jaundiced

what would you find on abdominal examination

Answer 7

generally no tenderness

maybe renal angle tenderness on palpation if there is retro-peritoneal inflamation

Question 8

What is hydronephrosis

Answer 8

When obstruction causes dilation of renal pelvis or ureter (hydrouretritis)

Question 9

Causes of obstruction within lumen

Answer 9

Calculus

blood clot

Malignancy

Question 10

Causes of obstruction within Wall

Answer 10

Pelviureteric neuromuscular dysfunction

Stricture

Congenital blader neck obstruction

Pin-hole meatus

Question 11

Causes of obstruction because of pressure from the outside

Answer 11

Compressions

Malignancy

Diverticulitis

Aortic aneurysm

Prostate

Question 12

a 32 year old male presents with left loin left upper quadrant pain radiating to the groin and not jaundiced

How would you manage this Px

Answer 12

First strong analgesia –> morphine

stones <4mm pass by themselves

stones >6mm most likely requires active intervention

antiemetics maybe for vomiting

alpha blockers

lithotripsy shock waves that shock the stone

ureteroscopy if lithotripsy fails

Question 13

what is MC&S

Answer 13

Microscopy culture and sensitivity