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Urinary Tract Obstruction (Aetiology (Hypercalcaemia, Renal tubular…
Urinary Tract Obstruction
Pathophysiology
Results in dilation of the tract proximal to the obstruction
Hydronephrosis
= Dilation of the renal pelvis
May be partial, complete, unilateral or bilateral
Leads to compression and thinning of the renal parenchyma - this leads to a decrease in kidney size
Obstruction can occur anywhere: from renal calyces to urethral meatus
Obstructing Lesions
Mural
Neuromuscular dysfunction
Schistosomiasis
Congenital or acquired stricture
Extra-mural
Retroperitoneal fibrosis
Post surgery
Abdominal or pelvic tumour
Luminal
Blood clot
Tumour
Stones
Aetiology
Hypercalcaemia
Renal tubular acidosis
Caliculi
Medullary sponge kidney
Gynaecological cancers
TB
Prostatic obstruction
Signs
Chronic upper urinary tract
Renal failure
Superimposed infection
Flank pain
Polyuria due to impaired urinary concentration
Acute lower urinary tract
Distended, palpable bladder - dull to percussion
Severe suprapubic pain due to acute urinary retention (600ml-1L residual urine)
Acute upper urinary tract
Superimposed infection with loin tenderness
Enlarged kidney
Loin pain radiating to groin
Chronic lower urinary tract
Distended, palpable bladder
Large prostate
Frequency, hesitancy, poor stream
Complications include UTI, urinary retention and obstructive uropathy
Investigations
Urine dipstick
Ultrasound
Bloods: U&Es, creatinine, FBC, PSA
If there is hydronephrosis (swelling of kidney due to urine) then do a CT to determine level of obstruction
Flow rates + residual volume
Treatment
Upper Tract
Ureteric stent - these can cause significant discomfort
Alpha blockers help reduce stent related pain
Nephrostomy
Lower Tract
Treat underlying cause e.g alpha blocker e.g. tamsulosin for prostatic obstruction
Monitor U&E and check for post-obstructive diuresis
Insert urethral or suprapubic catheter to relieve acute retention