Obstructive Uropathy



Obstructive Uropathy





Obstruction to urine flow can occur anywhere in the urinary tract. Proximal to the obstruction, pressures within the collecting system and renal tubules will rise. Ultimately, renal injury will result because of cellular atrophy and necrosis if the obstruction to urine flow is not relieved. Acute obstruction will produce distention of the bladder, ureter, or renal pelvis that is generally associated with pain. However, a slowly progressing obstruction can result in massive dilatation of the collecting system with no clinical symptoms. Recovery of some renal function can generally be expected in cases of complete unilateral ureteral obstruction if flow is restored within 6 weeks.


CAUSES OF OBSTRUCTION

The most frequent causes of obstruction in adult males are stones, benign prostatic hyperplasia, prostate cancer, ureteropelvic junction (UPJ) obstruction, and ureteral strictures, whereas in females the most frequent causes are pregnancy, stones, UPJ obstruction, pelvic malignancies, and surgical trauma to the ureters. In children, UPJ obstruction, ureterovesical junction obstruction (e.g., ectopic ureters), ureteroceles, urethral valves, and stones are most frequently responsible for urinary obstruction.

Causes of obstruction can be more systematically evaluated by location.








▪ Bladder Outlet Obstruction























Mechanical


Functional


Benign prostatic hyperplasia


Neurogenic (detrusor-sphincter dyssynergia)


Urethral stricture


Pharmacologic


Bladder neck contracture


Posterior urethral valves


Ureteroceles


Urethral stone


Foreign body











▪ Ureteral Obstruction



























Intrinsic Obstruction


Extrinsic Obstruction


Stones


Pregnancy


Tumors


Tumor


Strictures (tuberculosis, radiation, previous instrumentation)


Retroperitoneal fibrosis


Adynamic segment at UPJ


Crossing blood vessel to lower pole of kidney (UPJ)



Retrocaval ureter



Pelvic lipomatosis



Iatrogenic ligature



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Jun 10, 2016 | Posted by in UROLOGY | Comments Off on Obstructive Uropathy

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