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OBSTRUCTIVE UROPATHY

Explore the definition, causes, and pathophysiology of obstructive uropathy, including LUTO and UUTO. Learn about the presentation, diagnosis, and treatment options for this condition to prevent complications like renal failure.

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OBSTRUCTIVE UROPATHY

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  1. OBSTRUCTIVE UROPATHY By ;Dr ESSIEN Dept of surgery NHA

  2. Outline • Definition • Pathophysiology • Causes • Presentation • (Ix, Treatment)

  3. DEFINITION • Obstruction to urine flow which causes deterioration of renal function

  4. Types • Lower urinary tract obstruction(LUTO)- obstruction to urine flow from bladder neck to ext urethral meatus • Upper urinary tract obstruction(UUTO)-obstruction to urine flow from ureteric orifice up to kidneys

  5. Pathophysiology-LUTO -1 • Urethra-narrow, lengthened, tortous,outflow resistance • Bladder- hypertrophy, trabeculation sacculation, diverticulum, atony,residual urine, retention,ca

  6. Pathophysiology-LUTO-2 • Ureter-hydroureter, kinking • Kidney-hydronephrosis, renal failure • General- stasis,infection, calculi,ca

  7. Pathophysiology-UUTO • Increased peristalsis→Hypertrophy of ureteral musculature • Progressive back pressure →hydroureteronephrosis • Elongation and tortuosity of the ureter • The ureter may become so attenuated as to resemble a loop of bowel. • ↑ intra renal pressure → ↓renal blood flow, ↓GFR , loss of nephrons. • Significant cortical atrophy is associated with functional renal impairment. • Post obstructive diuresis.

  8. CAUSES- LUTO IN ADULTS • Mechanical obs urethra- US, BPH, Ca P, Bladder neck dyssernegia, Ca bladder, stones, urethral ca, meatal stenosis, BN contracture • Inflammation • Trauma • Neurogenic

  9. CAUSES- LUTO IN CHILDREN • Meatal ulcer with scabbing • Meatal stenosis/ congenital urethral stricture • PUV • Phimosis,Paraphimosis • Stones • Urethral ca, rupture • Foreign bodies • Bladder neck dyssernergia • Neurogenic- SB

  10. CAUSES- LUTO IN FEMALES • Post-op • Retroverted gravid uterus, impacted pelvic mass, fibroids • Ca bladder, calculi, • Urethral caruncle, urethral rupture • Bladder neck dyssernergia • Neurogenic bladder-Multiple sclerosis etc • Hysteria Dakum NK

  11. UUTO-Unilateral hydronephrosis • Intramural-PUJ obs,cong stenosis, stricture, ureterocoele,cong small ureteric orifice, ca (bladder, ureter) ,megaureter, • Intraluminal-stone,sloughed papilla • Extramural-adjacent ca,idiopathic retroperitoneal fibrosis, retrocaval ureter

  12. BILATERAL HYDRONEPHROSIS-CAUSES • All causes of LUTO • All causes of UUTO occurring bilaterally

  13. B- PUJ obs

  14. Aberrant vessel-treated by Hellstrom technique

  15. Retrocaval ureter

  16. Presentation-LUTO • Irritative- frequency, urgency, nocturia, urge incontinence, pain on micturition, nocturia. • Obstructive- delay, straining, poor stream, overflow incontinence, dribbling, sense of incomplete voiding, intermittency. • Others - haematuria, etc • Fxs of underlying cause & CRF

  17. Presentation-UUTO • Loin pains, colics, haematuria, fxs of UTI, • Hydronephrosis • Fxs of underlying cause & CRF

  18. Investigation • Assess renal function • Radiology- • plain abd x-ray • USS • Contrast-IVU, urethrocystography • CT, MRI • Endoscopy • Ix depending on cause

  19. Treatment • Optimize renal function • LUTO- Catheter, SPC • UUTO- J-J stent, Percutaneous nephrostomy, ureterostomy • Low protein diet if CRF • Fluid balance if CRF • Treat infection, anaemia, renal failure, etc • Treat cause

  20. summary • Defn-Obstruction + renal impairment • From upper or lower UT obstruction • Eventually upper tract affected • Treatment depends on cause • Necessary to detect early to prevent complications esp renal failure

  21. THANK YOU!!!

  22. ‘You weren’t put on earth to be remembered.You were put here to prepare for eternity.’-Rick Warren

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