urinary tract obstruction

Classification: Ureter
– Intrinsic :Ureteropelvic junction stricture /Ureterovesical junction obstruction /Papillary necrosis /Ureteral folds /Ureteral valves /Ureteral stricture (iatrogenic) /Blood clot /Benign fibroepithelial polyps /Ureteral tumor /Fungus ball /Ureteral calculus /Ureterocele /Endometriosis /Tuberculosis /Retrocaval ureter – Functional: Gram-negative infection /Neurogenic bladder
WORKUP: Imaging Studies
CT scan with intravenous contrast demonstratin g pooling of contrast and delayed excretion of contrast from a left-sided ureteropelvic junction obstruction
CT scan without contrast demonstrati ng severe left-sided hydronephro sis secondary to a ureteropelvic junction obstruction.
WORKUP: Imaging Studies
Retrograde pyelogram demonstrating a ureteropelvic junction obstruction secondary to crossing vessels .
Classification: Ureter
– Extrinsic
• Retroperitoneal lymphoma /Retroperitoneal sarcoma /Cervical cancer /Prostate cancer /Retroperitoneal fibrosis /Aortic aneurysm /nflammatory bowel disease /Ovarian vein syndrome /Retrocaval ureter /Uterine prolapse /Pregnancy/Iatrogenic ureteral ligation /Ovarian cysts /Diverticulitis /Tuboovarian abscess /Retroperitoneal hemorrhage /Lymphocele
– Extrinsic Benign prostatic hyperplasia
CLINICAL :History
1..With acute obstruction, patients may present with pain, which is usually described as severe, intermittent, and dull. Patients may describe worsening of pain with consumption of fluids. Depending on the level of hydroureter, pain may radiate to the ipsilateral testicle or labia. Often associated with nausea and vomiting. 2..Hydronephrosis may develop silently, without symptoms, as the result of advanced pelvic malignancy.
WORKUP: Imaging Studies
• Intravenous pyelogram demonstrating a ureteropelvic junction obstruction with dilation of the collecting system and lack of excretion of contrast.
– Functional
• Neurogenic bladder • Vesicoureteral reflux
– Extrinsic Pelvic lipomatosis
Urethral
– Intrinsic
• • • • • Urethral stricture Urethral valves Urethral diverticula Urethral atresia Labial fusion
WORKUP :Lab Studies
• Urinalysis: Assess for signs of infection. Pyuria suggests the presence of infection. Microscopic hematuria may indicate the presence of a stone or tumor. • Complete blood cell count: Leukocytosis may indicate acute infection. • Serum chemistry: Bilateral hydronephrosis and hydroureter can result in an elevation of BUN and creatinine levels. In addition, hyperkalemia can be a life-threatening condition.
WORKUP: Imaging Studies
Retrograde pyelogram demonstrating a ureteropelvic junction obstruction secondary to annular stricture.
WORKUP: Imaging Studies
Classification: Bladder
– Intrinsic
• • • • • • Bladder carcinoma Bladder calculi Bladder neck contracture Cystocele Primary bladder neck hypertrophy Bladder diverticula
CLINICAL : Physical
• With severe hydronephrosis, the kidney may be palpable. • With bilateral hydronephrosis, lower extremity edema may occur. Costovertebral angle tenderness on the affected side is common. • A palpably distended bladder adds evidence of lower urinary tract obstruction. • A digital rectal examination should be performed to assess sphincter tone and to look for hypertrophy, nodules, or induration of the prostate.
urinary tract obstruction
Synonyms and related keywords
urinary tract obstruction, renal pelvis dilation, calyces dilation, hydroureteronephrosis, hydronephrotic system, pyonephrosis, urine flow interruption, interrupted urine flow, pyelolymphatic backflow, renal colic, advanced pelvic malignancy, prostatic hypertrophy, prostate cancer, cervical cancer, pregnancy, ureter calculi, ureteral calculi, ureteropelvic junction obstruction, UPJ obstruction, urine reflux, postobstructive diuresis
Pathophysiology
• Hydronephrosis can result from anatomic or functional processes interrupting the flow of urine. This interruption can occur anywhere along the urinary tract from the kidneys to the urethral meatus. • A multitude of causes exist for hydronephrosis and hydroureter. Classification can be made according to the level within the urinary tract and whether the etiology is intrinsic, extrinsic, or Functional .
WORKUP: Lab Studies
All patients should be evaluated with a CBC count, coagulation profile, electrolyte level, and assessment of overall renal function with BUN and creatinine and urine culture.
WORKUP : Imaging Studies
• • • • • • Ultrasound Intravenous pyelogram CT scan MRI Plain film Radionuclide studies
Baidu Nhomakorabea

Ureteropelvic Junction Obstruction
UPJ obstruction
• UPJ obstruction is defined as an obstruction of the flow of urine from the renal pelvis to the proximal ureter. The resultant back pressure within the renal pelvis may lead to progressive renal damage and deterioration. • UPJ obstruction presents most frequently in childhood, but adults and elderly individuals also can present with a primary obstructive lesion. In adults, other etiologies for ureteral obstruction must be considered, including stones, ureteral compression from extrinsic processes, retroperitoneal fibrosis, and other inflammatory processes.