Urinary Tract Obstruction Flashcards Preview

Renal Pathology > Urinary Tract Obstruction > Flashcards

Flashcards in Urinary Tract Obstruction Deck (23)
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1
Q

Types of urinary tract obstruction

A
Upper tract (i.e. supra-vesical)
- PUJ
- ureter
- VUJ
Lower tract (i.e. bladder outflow obstruction)
- bladder neck 
- prostate
- urethra
- urethral meatus
- foreskin e.g. phimosis
2
Q

Causes of obstruction at the pelvi-ureteric junction (PUJ)

A
PUJ obstruction 
- physiological
- crossing vessel 
Stone
Ureteric tumour (TCC)
Blood clot
Fungal ball
Lymph node tumour
Abdominal mass tumour
3
Q

Causes of ureteric obstruction

A
Stone
Ureteric tumour (TCC)
Scar tissue 
Blood clot
Fungal ball 
Lymph nodes
- tumour
- retroperitoneal fibrosis
Iatrogenic
Abdominal/pelvic mass
- tumour
- pregnant uterus
4
Q

Causes of vesico-ureteric junction obstruction

A
Stone
Ureteric tumour
Bladder tumour
Cervical tumour
Prostate cancer
5
Q

Presentation of upper urinary tract obstruction

A
Pain 
Frank haematuria
Symptoms of complications
Palpable mass
Microscopic haematuria
6
Q

Complications of upper urinary tract obstruction

A

Infection and sepsis

Renal failure

7
Q

What is the chance of death with an obstructed infected kidney?

A

1 in 5

8
Q

Treatment of infected pyelonephritis and sepsis

A

Antibiotics
Fluid
Analgesics

9
Q

Treatment of upper tract obstruction

A
Resuscitation 
Emergency treatment of obstruction (for unremitting pain or complications)
- percutaneous nephrostomy insertion 
- retrograde stent insertion 
Treat underlying cause
10
Q

How to treat a stone causing obstruction

A

Ureteroscopy and laser lithiotripsy +/- basketing or ESWL

11
Q

How to treat a ureteric tumour

A

Radical nephron-ureterectomy

12
Q

How to treat a PUJ obstruction

A

Laparoscopic pyeloplasty

13
Q

Presentation of lower tract obstruction

A
LUTS 
- including incontinence
Acute urinary retention 
Chronic urinary retention
Recurrent UTI and sepsis
Frank haematuria
Formation of bladder stones
Renal failure
14
Q

Treatment of lower urinary tract obstruction

A
Resuscitation 
Emergency treatment of obstruction (if unremitting pain or complications)
- urethral catheterisation 
- suprapubic catheterisation 
Treatment of obstruction
15
Q

Investigations of lower urinary tract obstruction

A

Bladder scan

USS renal tract

16
Q

How to treat BPE causing obstruction

A

TURP

17
Q

How to treat a urethral stricture causing obstruction

A

Optical urethrotomy

18
Q

How to treat metal stenosis causing obstruction

A

Meatal dilatation

19
Q

How to treat phimosis causing obstruction

A

Circumcision

20
Q

Presentation of high pressure chronic retention

A

Painless
Incontinent
Raised creatinine
Bilateral hydro-nephrosis

21
Q

Presentation of low pressure chronic retention

A

Painless
Dry
Normal creatinine
Normal kidneys

22
Q

Complications of lower tract obsctruction

A

Decompression haematuria

Post obstructive diuresis

23
Q

What is decompression haematuria?

A

Shearing of small vessels due to differing compliance of tissue layers