Obstruction, Retention Flashcards Preview

MS4 - Renal/Urology > Obstruction, Retention > Flashcards

Flashcards in Obstruction, Retention Deck (22)
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1
Q

Causes of urinary tract obstruction

A
  1. Luminal
  2. Mural
  3. Extramural
2
Q

Luminal causes of obstruction

A

Stones

Blood clots

Sloughed papilla

3
Q

Mural causes of obstruction

A

Stricture

Tumour

Neuromuscular dysfunction

4
Q

Extramutal causes of obstruction

A

Prostatic enlargement

Abdo / pelvic mass / tumour

Retroperitoneal fibrosis

5
Q

Upper urinary tract obstruction sx

A

Flank plain

Renal failure

6
Q

Lower urinary tract obstruction

A

Voiding sx

Distended, palpable bladder ± large prostate on PR

7
Q

Upper tract obstruction rx

A

Nephrostomy or

Ureteric stent

8
Q

Lower tract obstruction rx

A

catheter

9
Q

Ureteric stent complications

A

Infection/inflammation

Haematuria

Encrustation

Obstruction

Ureteric rupture

Stent migration

10
Q

Urethral stricture causes

A

Trauma

Infection: e.g. gonorrhoea

Chemotherapy

Balantitis xerotica obliterans

11
Q

Presentation of urethral stricture

A

Voiding sx

12
Q

Examination for urethral stricture

A

PR

Palpate urethra through penis

Examine meatus

13
Q

Investigations for urethral stricture

A
  1. Urodynamics
  2. Urethroscopy and cystoscopy
  3. Retrograde urethrogram
14
Q

Urodynamic testing results of a urethral stricture

A

↓ peak flow rate

↑ micturition time

15
Q

Treatment of urethral stricture

A

Internal urethrotomy

DilatationStent

16
Q

Chronic urinary retention classification

A
  1. High Pressure High detrusor pressure at end of micturition Typically bladder outflow obstruction Bilateral hydronephrosis and ↓ renal function
  2. Low Pressure Low detrusor pressure at end of micturition Large volume retention, very compliant bladder Kidney able to excrete urine No hydronephrosis - normal renal function
17
Q

High pressure urinary retention features

A

High detrusor pressure at end of micturition

Typically bladder outflow obstruction

Bilateral hydronephrosis and ↓ renal function

18
Q

Low pressure urinary retention features

A

Low detrusor pressure at end of micturition

Large volume retention, very compliant bladder

Kidney able to excrete urine

No hydronephrosis - normal renal function

19
Q

Treatment of high pressure chronic urinary retention

A

Catheterise and consider TURP

20
Q

Treatment of low pressure chronic urinary retention

A

Avoid catheters

Early TURP

21
Q

Contraindications of suprapubic catheterisation

A

Known or suspected bladder carcinoma

Undiagnosed haematuria

Previous lower abdominal surgery - adhesions of small bowel

22
Q

Clean Intermittent Self-Catheterisation (CISC)

A

Alternative to permenant catheter

Useful in patients with failure to void after TURP