Urinary Tract Obstruction

Question 1

What are the types of UTO? (3x2 types)

Answer 1

1. Acute vs Chronic
2. Partial vs Complete
3. Unilateral vs Bilateral

Question 2

What are the luminal (lumen) causes of UTO? (4 things)

Answer 2

1. Stones
2. Bloodclart
3. Sloughed papilla
4. Tumour: renal, ureteric, bladder, BPH

Question 3

What are the mural (wall) causes of UTO? (3 things)

Answer 3

1. Congenital / acq stricture
2. Neuromuscular dysfunction
3. Schistosomiasis (parasitic worm infection)

Question 4

What are the extramural causes of UTO? (3 things)

Answer 4

1. Abd / pelvic : mass / tumour
2. Retroperitoneal fibrosis
3. Iatrogenic (Post surgery)
4. Anticholinergics
5. Alcohol
6. Constipation
7. DM

Question 5

What are the pathophysiological steps of UTO harming the kidney? (7 steps)

Answer 5

1. Obst
2. Renal tubular cell apoptosis
3. Cytokine release + inflamm response
4. Caspases generated
5. Caspases mediate renal tubular apoptosis
6. Prolonged obs process -> induces tubulointerstitial fibrosis + inflamm
7. Accum ECM + promotes fibrosis

Question 6

Why are glomerular cells not affected by UTO like tubular cells are?

Answer 6

Glomerular cells resistant to obs related apoptosis

Question 7

What are the clinical features of ACUTE UPPER UTO? (3 things)

Answer 7

1. Loin pain (radiates to groin) / tenderness
2. Enlarged kidney
3. Superimposed inf

Question 8

What are the clinical features of CHRONIC UPPER UTO? (4 things)

Answer 8

1. Flank pain
2. Renal failure
3. Superimposed inf
4. Polyuria (bc impaired urinary conc)

Question 9

What are the clinical features of ACUTE LOWER UTO? (4 things)

Answer 9

1. Confusion (elderly)
2. Severe suprapubic pain
3. Distended palpable bladder
4. Bladder contains 600ml + DULL to percuss

Question 10

What are the clinical features of CHRONIC LOWER UTO? (7 things)

Answer 10

1. Frequency
2. Hesitancy
3. Poor stream
4. Terminal dribbling
5. Overflow incontinence

@ exam

6. Distended palpable bladder
7. Large prostate @ PR

Question 11

What are the complications of CHRONIC LOWER UTO? (3 things)

Answer 11

1. UTI
2. Urinary retention
3. Renal failure

Question 12

What lab tests should be done for suspected UTO? (5 things)

Answer 12

1. FBC
2. U&Es (High K)
3. Creatinine (raised)
4. PSA
5. Urine dipstick

Question 13

What diagnosis does a High potassium + Renal tubular acidosis result in blood tests confirm?

Answer 13

CHRONIC Obst

Question 14

Why do you get Renal tubular acidosis in UTO?

Answer 14

Bc mineralcorticoid resistance impairing distal Na abs

Question 15

What is the gold standard imaging for UPPER UTO?

Answer 15

US

Question 16

When should a CT be done for UTO?

Answer 16

In hydronephrosis / hydroureter (distension of renal pelvis + calyces / ureter)

Question 17

What will a CT determine in UTO?

Answer 17

Level of obst

Question 18

What is Radionuclide imaging used for in UTO?

Answer 18

Functional assessment of kidneys

Question 19

What is the main treatment of UTO?

Answer 19

Relieve cause of obst

Question 20

What are the treatment options for UPPER UTO? (2 things)

Answer 20

1. Nephrostomy / ureteric stent

2. Pyeloplasty (to widen pelvic-ureteric junction if blocked)

Question 21

What should be given with a ureteric stent to reduce stent related pain?

Answer 21

alpha blockers

Question 22

What are the treatment options for LOWER UTO? (3 things)

Answer 22

1. Uethral / suprapubic catheter (to relieve acute retention)
2. TUC (e.g prostatic obst = alpha blocker)
3. Monitor weight + Fluid balance + U&Es

Question 23

When are the ONLY occasions you should catheterise a CHRONIC UTO patient? (3 things)

Answer 23

1. Pain
2. Urinary infection
3. Renal impairment

Question 24

If there is clot retention, what catheter should be done?

Answer 24

3 way catheter + wash out

Question 25

What should be done 2-3 days after catheter insertion?

Answer 25

TWOC (trial without catheter)