What You Will Learn
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- Obstructive Uropathy: Impedance in the flow of urine anywhere along the urinary tract
- Obstructive Nephropathy: Obstructive uropathy with derangement in renal function
| Acute | Chronic | |
|---|---|---|
| Unilateral | AU (1:1,000) | CU (5:1,000) |
| Bilateral | AB (5:10,000) | CB (1:1,000) |
Acute Unilateral
- Kidney and ureteric stones
- Ureteric injuries
- TAH
- APR
- Ureteral manipulative procedures
- VVF repair
- etc
- Ureteric tumours
- Blood clots
Chronic Unilateral
- Kidney stones
- PUJ obstruction
- Ureteric stones, tumours, strictures, megaureter
- Vesicoureteric reflux
- Invading tumours of adjacent organs
- Cervix
- Ovary
- Bladder
- Rectum
- Prostate
- Uterus
- Retroperitoneal tumours
- Retroperitoneal fibrosis
- Injuries
- TAH, APR, CS, VVF
Acute Bilateral
- Surgical injuries
- TAH, APR, CS, VVF repair
- Prostate
- BPH, prostate cancer, prostatitis, prostatic abscess
- Urethra
- Trauma, strictures, stones
- Bladder
- Tumours, cystoceles, retroverted uterus, pregnancy
- Clots, papillary necrosis
- Cervix cancer
- Posterior urethral valves
- Meatal stenosis
Chronic Bilateral
- PUJ obstruction
- Vesicoureteric reflux or obstruction
- Posterior urethral valves
- Meatal stenosis
- Prostate
- Urethra
- Cervix, uterus
History
- Bio data viz age, sex, occupation
- Loin pain, oliguria, anuria, oedema, hiccups
- Hesitancy, poor urine stream, straining, intermittency, incomplete bladder emptying, and retention
- 5Cs (complaint, course, cause, complications, care)
- Medication history
- Antihistamines, antipsychotics, antidepressants
- Ethylene glycol, indinavir, methotrexate, phenylbutazone, or sulfonamides
- Methysergide or other natural-occurring ergotamines
- Occupational exposure history
- Textile manufacturers, shipyard workers, roofers, or asbestos miners (retroperitoneal fibrosis)
- Textile workers, rubber manufacturing workers, leather workers, painters, hairdressers, drill press workers (bladder cancer)
- Review of other systems - very important
Physical Examination
- Signs of dehydration and intravascular volume depletion
- Peripheral edema, hypertension, signs of congestive heart failure
- Palpable kidney or bladder
- Enlargement of pelvic organs (e.g., prostate, uterus)
- Examination of external urethra for phimosis, meatal stenosis
Laboratory
- FBC
- E&U, Cr
- Urinalysis
- Urine mcs
- FBS
- PSA
Imaging
- Abdominal ultrasound
- Abdominal CT scan
- CT urography
- MRI urography
- Intravenous urography (IVU)
- Micturating cystourethrogram
- Retrograde urethrogram
- Renal nuclear scan
- Radionuclear cystography
note
Renal Nuclear Scan
- DSMA (Technetium Tc 99m dimercaptosuccinic acid) for cortical or parenchymal structure: pyelonephritis, scar, and solid renal masses. Determining relative (split) renal function, renal ectopia, infarction, horseshoe kidney, thrombosis, acute renal failure, MCDKs, and trauma
- 99m Tc-MAG3 (Technetium Tc 99m mercaptoacetythiglycine)
- Dynamic or functional scintigraphy
- Diuretic renal scintigraphy
- Post-transplant evaluation
- Obstruction
Temporary Relief
- Urethral catheter
- Suprapubic catheter
- Ureteric stent (Double J stent)
- Urethrostomy
- Ureterostomy: Tubed, non-tubed
- Nephrostomy
Permanent Correction
- Surgery - depends on the aetiology
- Urethroplasty
- Prostatectomy
- Others:
- Pyeloplasty
- Nephrectomy
- Etc
- Radiotherapy for malignant obstruction
- Recurrent UTI
- Loss of kidney
- Renal failure
- Hypertension
- Stone formation
- Post-decompressive hematuria
- Post-obstructive diuresis
- 200ml/hour
Practice Questions
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