Urinary Tract Obstruction Flashcards
what are the causes of obstruction of the upper urinary tract?
- PUJ obstruction
- stone (PUJ or ureter)
- ureteric tumour (TCC)
- blood clot (PUJ or ureter)
- fungal ball (PUJ or ureter)
- scar tissue in ureter
what are causes of urinary tract obstruction at the vescio-ureteric junction?
intrinsic:
- stone
- bladder tumour
- ureteric tumour
extrinsic:
- cervical tumour
- prostate cancer
what are the 3 main sites of urinary tract obstruction?
Pelli-Ureteric junction (PUJ)
ureter
vesico-ureteric junction (VUJ)
what is the immediate management of upper urinary tract obstruction?
percutaneous nephrostomy insertion
retrograde stent insertion
what are the complications from upper urinary tract obstruction ?
infection (i.e. UTI)
sepsis
renal failure
what is the signs & symptoms of upper urinary tract obstruction?
pain frank haematuria symptoms of complications palpable mass microscopic signs of complications
what are the signs/symptoms of lower urinary tract obstructiom?
LUTS acute/chronic urinary retention recurrent UTI sepsis frank haematuria formation of bladder stones renal failure
what is the immediate treatment of lower urinary tract obstruction?
urethral or suprapubic catheterisation
then treat underlying cause
what are the 3 subtypes of chronic retention ?
high pressure
low pressure
what is the presentation of high pressure chronic retention ?
painless
incontinent
raised creatinine
bilateral hydronephrosis
what is the presentation of low pressure chronic retention?
painless
dry
normal creatinine
normal kidneys
what are the complications of chronic retention ?
decompression haematuria obverflow incontinence recurrent UTI sepsis post obstructive diuresis electrolyte abnormalities persistant renal dysfunction due to acute tubular necrosis
what is decompression haematuria?
after catheterisation to treat chronic retention, the difference in compliance of the tissue layers that have been stretched results in shearing of small vessels
self-limiting
where are the sites in the lower urinary tract where benign outflow tract obstruction can occur?
bladder neck prostate urethral urethral meatus foreskin
what is the main risk factor for acute urinary retention?
benign prostate hyperplasia/enlargement
