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Urinary Obstruction Flashcards

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1
Q

Where is your upper urinary tract

A

Pelvic ureteric junction to vesicoureteric junction

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2
Q

What causes upper tract obstruction at PUJ, ureter and VUJ

A 
Scar tissue causing ureteric stricture 
Stone
Tumour - ureteric / kidney 
Blood clot 
Abdominal / pelvic mass causing external compression 
Prostate / cervical tumour near VUJ
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3
Q

What can obstruction be

A

Luminal e.g. clot / stone / tumour
Mural e.g. stricture / neuromuscular
Extra-mural e.g. compression tumour / fibrosis

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4
Q

What is an emergency and when do you consider it

A

Obstructed kidney with infection
Bilateral obstruction
Consider in any patient with impaired renal function

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5
Q

What are symptoms of acute obstruction

A 
Loin pain radiating to groin
Frank haematuria
Vomiting
Microscopic haematuria
Reduced urine output 
Sepsis / infection
Renal failure 
May have enlarged kidney
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6
Q

What can the haematuria be

A

Intermittent so beware of this

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7
Q

What are signs of infected acute obstruction

A 
Sepsis
Fever
Low BP
Low O2 
N+V
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8
Q

What does intermittent frank haematuria suggest

A

Can query UTI
But if comes back after Rx
think obstruction

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9
Q

What can chronic upper tract obstruction present with

A

Flank pain
Renal failure
Infection
Polyuria may occur due to impaired concentration

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10
Q

What investigations should you do for obstruction

A 
FBC, U+E
ABG if hypoxic
PSA
Urine dip and MC+S 
Blood culture if fever
Imaging
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11
Q

What imaging

A

USS if middle of night and no CT

CT KUB = gold standard for determining level

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12
Q

How do you treat obstruction

A 
ABC
IV access
IV fluid
Broad Ax
Analgesia
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13
Q

What is emergency Rx for obstruction

A

Percutaenous nephrostomy into back or stent

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14
Q

What should you never give if septic

A

Shockwave therapy

Do when well

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15
Q

What is definite treatment of obstruction

A

Depends on cause
Stone = ESWL or utereoscopy if doesn’t work
Tumour = nephro-ureterectomy
PIJ obstruction = pyeloplasty to widen PUJ

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16
Q

What ae complications of placement of a stent

A 
Pain 
Irritation
Haematuria
Infection
Biofilm 
Obstruction
Ureteric rupture
Misplacement
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17
Q

What causes lower urinary tract obstruction (bladder to urethral meatus)

A 
Obstruction at
Bladder neck - neurogenic bladder 
Prostate - BPH / prostate cancer 
Urethra - stricture 
Urethral meatus
Foreskin
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18
Q

What are the symptoms of lower urinary tract obstruction

A 
Acute urinary retnetion
Voiding and storage Sx
Incontinence
Recurrent UTI
Frank haematuria
Sepsis 
Renal failure on bloods
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19
Q

How do you investigate

A

Bloods
ABG
Bladder USS as retention

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20
Q

How do you treat lower urinary tract obstruction

A

Catheterise IMMEDIATELY to relieve retnetion

Treat cause

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21
Q

What do you do for BPE

A

TURP

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22
Q

How do you treat urethral stricture

A

Urethrotomy

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23
Q

How do you treat mental stenosis or phimosis

A

Meatal dilatation

Circumcision

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24
Q

What are complications of obstruction

A 
Pain 
Sepsis
Bladder stones
Hydronephrosis 
Renal failure -> CKD
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25
What can trigger acute urinary retention
Constipation Alcohol Post op
26
What should you think if acute urinary retention
``` Obstruction Drugs Infection Neurogenic Post-op ```
27
What can cause acute urinary retention
``` BPH = most common CAUDA EQUINA Constipation Drugs UTI / infection - enough to cause if predisposed Blocked catheter Urethal stricture Meatal stenosis / phimosis Blood clot Pelvic trauma or surgery Pelvic mass Prolapse Fouler sundrome MS / Parkinson ```
28
What drugs can cause acute urinary retention
``` ANTI-CHOLINERGIC - TCA / anti-psychotic / anti-histamine Diuretic CCB Opiates Benzo Alcohol Spinal / Epidural ```
29
What is fouler syndrome
Urethra doesn't relax
30
What causes a stricture
``` Iatrogenic STI Hydrospadia Lichen sclerous Lichen Planus ```
31
What are the symptoms of acute urinary retention
``` Painful - extreme SUDDEN - over a few hours Inability to void Palpable or perusable bladder Restless May have tachycardia from the pain ```
32
If someone had a background of retention how would it present
Overflow
33
What are red flags in acute urinary retention
Cauda equina - pain / saddle dysathesia / weakness Weight loss Bone pain - mets Blood
34
Who is at risk of retention
``` BPH Catheter removed Constipation Immobility Opiates Infection Haematuria - as can clot Rare in women ```
35
If a hx of pelvic fracture + retention what do you suspect
Bladder or urethral injury | Bladder perforation is peritonitis / no UO
36
How do you investigate acute urinary retention / examine
``` Bloods - FBC, U+E, PSA, glucose Urine dip + MC+S Abdo exam DRE for BPH Neuro exam Pelvic exam in women Bladder scan >300ml USS MRI / CT head if neurological suspected ```
37
What volume in bladder
500ml-1l
38
What do you do if abnormal U+E
USS to rule out hydronephrosis | CT KUB if USS shows hydronephrosis
39
If >1l residual in bladder what do you do
Check U+E | Monitor for post obstructive diuresis
40
How do you treat acute urnary retention
CATHETER - always needed | 3 way catheter if clot retention
41
What do you monitor
Weight Urine output Fluid balance U+E
42
What bloods
FBC, U+E, CRP, PSA | ABG
43
What is low risk
<1000ml residual Normal U+E Uncomplicated
44
What do you do for low risk
Discharge Treat cause i.e. AX or laxatives TWOC
45
If due to BPE
A blocker Remove catheter in 2 days TURP if this fails
46
If due to clot retention
3 way catheter | Bladder wash out
47
What suggests clot retention
Haematuria | No longer peeing
48
What is high risk
>1000ml Abnormal U+E Complications e.g. UTI
49
How do you treat
Admit Hourly urine output Monitor for post obstructive diuresis IV fluid if >200ml / hr for 2 hours
50
What do you do if failure to void
Catheterise
51
What do you do if renal impairment
Surgery | No medical
52
What are complications of urinary retention
UTI Bladder stone Renal failure Electrolyte imbalance
53
What can happen after the catheter is put in
Post obstructive diuresis Haematuria Na and bicarbonate losing nephropathy
54
What causes pathological diuresis
Urea, ADH and altered tubular function | Na and H20 released after catheter inserted
55
What are the symptoms
AKI due to dehydration Postural hypo Weight loss
56
How do you treat
Monitor UO to make sure not increasing Monitor U+E Give IV fluids to match output
57
What is Na and bicarb losing nephropathy
Lost in urine when catheter inserted Replace Withhold nephrotoxin Can cause metabolic acidosis
58
What causes chronic urinary retention
``` BPH = very common Detrusor under activity Neuropathic bladder - MS /nerve / mets / CNS / DM Infection Obstruction/ pelvic mass ```
59
What are symptoms of chronic urinary retention
Painless Palpable and percussion bladder May have large prostate Often able to void but left with residual urine LUTS e.g. frequency, hesitancy, poor stream Overflow due to high pressure Abnormal U+E
60
When should you worry
Patients with high pressure retention or hydronephrosis
61
How do you investigate
``` Bloods inc ABG MSSU Post void bladder scan / USS Flow rate study - if high pressure worry Cystoscopy for bladder CT ```
62
When do you Catherterise
If pain, infection or renal impairment | 1st line = CISC before long term / suprapubic
63
What requires immediate treatment
High pressure retnetion
64
When do you do CISC
Neuro | Renal
65
What are complications
UTI Bladder stone Renal failure if bilateral uropathy / hydronephrosis Hyperkalaemia Acidosis due to renal failure? / loss of bicarb - resp compensated
66
What are CI to suparapubic catheter
Any surgery or scar tissue Bladder cancer Anti-coagulant
67
How does acute on chronic cpresent
May go unnoticed Overflow Pain
68
How do you investigate
Bloods | Bladder scan
69
What should you do if abnormal U+E
Renal USS
70
How do you treat
Catheterise | Renal function should return to baseline
71
What can residual volume and creatinine be in chronic
1.5l | 1000
72
What is normal residual volume
<50ml
73
What are causes of urethral stricture
Hydrospasia Iatrogenic STI Lichen sclerous
74
How does it present
LUTS
75
If patient has urethral injury due to pelvic injury what is Rx if bladder distended
Suprapubic catheter
76
What is classified as high pressure retention
If renal function impaired or there is hydronephrosis
77
What do you do before TWOC
Give tamsulosin to prepare (A blocker) | 24-72 hours before
78
What can you do if suspect neurogenic cause
MRI / CT head
79
How does urethral injury present
Inability to pass urine Blood at meatus Palpable bladder Perineal bruising
80
What is Rx of bladder distension
Suprapubic catheter under USS | Can try one pass at urethral
81
How do you Dx
Urethrogram | - Contrast into bladder

Renal / Urology (16 decks)

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