Flashcards in Urinary Tract Obstruction Deck (55)
When may a unilateral urinary tract obstruction be clinically silent?
If the other kidney is functioning normally
What are some examples of when a urinary tract obstruction requires urgent treatment?
If the obstruction is bilateral, or there is obstruction with infection
How does an acute upper urinary tract obstruction typically present?
Loin to groin pain
Symptoms of loin pain, renal failure, superimposed infection and polyuria suggest what type of urinary tract obstruction?
Chronic upper urinary tract obstruction
Why does chronic upper urinary tract obstruction cause polyuria?
There is a reduced concentrating ability of the kidney
How does an acute lower urinary tract obstruction typically present?
Acute urinary retention
Overflow incontinence can be a feature of which type of urinary tract obstruction?
Chronic lower urinary tract obstruction
If a patient presents with any signs/symptoms of urinary tract obstruction, what two bedside tests must always be done?
Bloods for U&Es, urine for MC&S
What is the first line imaging modality of choice for someone with a suspected urinary tract obstruction?
When should a CT scan be arranged for someone with urinary tract obstruction?
If there is hydronephrosis or hydroureter on ultrasound scans
What are the two main treatment options for an upper urinary tract obstruction?
Nephrostomy or ureteric stent
What medication can be used to help reduce the pain associated with a ureteric stent?
How is a lower urinary tract obstruction treated?
Insert a catheter and treat the underlying cause if possible
What are the two main causes of urinary retention?
Obstruction, or reduced detrusor muscle power
What are the two main causes of acute urinary retention?
Prostatic enlargement and urethral strictures
What group of medications are a recognised cause of acute urinary retention?
If a patient is in acute urinary retention and fails to void, how should they be treated?
Catheterisation and an alpha blocker (e.g. tamsulosin)
How are patients who are in acute urinary retention as a result of clot retention treated?
3-way catheter and bladder washout
Why should patient's U&Es always be monitored closely after catheterisation for acute urinary retention?
Risk of post-obstructive diuresis and salt-losing nephropathy
Why may chronic urinary retention lead to renal failure?
Bilateral obstructive nephropathy
Treating the underlying cause is the best way to manage chronic urinary retention. What else can be used to help control the condition, regardless of the underlying cause?
Intermittent self catheterisation
In patients with chronic urinary retention, an episode of acute urinary retention may only be recognised when what symptom develops?
After placing a catheter in someone with acute-on-chronic urinary retention, what may happen with regards to their renal function?
There may be a significant rise in creatinine, but this usually returns to baseline after a few days
If you suspect obstructive uropathy, what imaging investigation should always be requested?
What can be done to try and avoid post-obstructive diuresis in patients who have been catheterised as a result of urinary retention?
Give resuscitation fluids, and then match input with output
What can be done to try and avoid salt-losing nephropathy in patients who have been catheterised as a result of urinary retention?
Give isotonic (1.26%) sodium bicarbonate solution and withhold any nephrotoxic drugs
What type of disorder is idiopathic retroperitoneal fibrosis?
What type of urinary tract obstruction is caused by retroperitoneal fibrosis?
Progressive, bilateral urinary tract obstruction
What type of malignancy is a recognised secondary cause of retroperitoneal fibrosis?