Please enable JavaScript.
Coggle requires JavaScript to display documents.
Urinary tract obstruction (Aetiology (Mural (Degenerative Neuromuscular e…
Urinary tract obstruction
Definition
Blockage of UT at any point from
the kidney to the urethral meatus
Aetiology
Mural
Degenerative
Neuromuscular e.g. neuropathic bladder
Infection
e.g. schistosomiasis
Iatrogenic/idiopathic
Stricture
Congenital
Congenital deformities
Extramural
Vascular
AAA
Degenerative
Diverticulae
Retroperitoneal fibrosis
Neoplastic
Abdo/pelvic/prostate Ca
BPH
Iatrogenic
Post surgery
Luminal
Vascular
Blood clot
Neoplastic
Renal/ureter tumour
Metabolic
Stones, caliculi
Idiopathic
Sloughed papilla
Pathophysiology
Partial or complete obstruction, uni or bilateral
Dilation of tract proximal to blockage,
due to high intramural pressure
Anywhere from renal calyces to urethral meatus
Clinical
presentation
Abdo pain
Radiation
Loin to groin if upper UT
Character
Colicky
Associated symptoms
Infective - fever, haematuria, LUTs
Obstruction - freq, hesitancy, poor flow,
terminal dribble, overflow incontinence
Onset
Insidious
Site
Loin to groin (acute upper UT)
Flank (chronic upper UT)
Suprapubic (acute lower UT)
Nil (chronic lower UT)
Timing
Progressive
Exacerbating/relieving factors
Cant get comfortable
Severity
Upper UT often excruciating
Infection symptoms
Outflow obstruction
symptoms
Diagnosis
Examination
PR exam
May have enlarged prostate
Abdo exam
Tenderness (loin/flank), palpable kidney
(acute upper), distended, palpable bladder
Investigations
Bedside
Obs - may have fever
Bloods
FBC, CRP, U+E
Urine
Dipstick
MCS
Imaging
USS KUB (caliculi)
CT KUB (level of obstruction)
Special tests
Excretion urography
Antegrade/retrograde pyelography
Cystoscopy
Flow studies
History
SH
Livinh arrangements, occupation,
smoking, alcohol, travel
DH
Current meds, allergies
PMH
UT disease, medical conditions,
previous surgeries
PC/HPC
Abdo pain, LUTS, fever,
reduced UO, overflow incontinence
Management
Initial ABCDE
Definitive
Surgery
Lower UT
Catheterise (urethral, suprapubic)
Upper UT
Ureteric stent (SEs pain, haematuria, infection)
Pyeloplasty (widen PUJ)
Nephrostomy
Medical
Treat underlying cause
Complications
Retention
Large diuresis after relief of obstruction
(renal conc defect, can get salt -losing nephropathy)
Monitor fluid balance, weight, U+Es
UTI