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The old enemy: Obstructive uropathy

Obstructive uropathy is indeed a dreadful condition to have and it’s a urological emergency. There are multiple causes depending on age, gender and co-morbidity of the individual from urinary tract stones, malignancy, benign prostatic hypertrophy, posterior urethral valve, uterine fibroid, trauma and infection, among other... Unfortunately, obstructive uropathy accounts for 2% for all new cases of end stage renal disease(ESRD) that are beginning treatment with nearly 50% of this patients below the age of 65 years. Patients may be asymptomatic or presents classically with renal colic pain, urinary symptoms such as decreased frequency, hesitancy, incontinence or urgency, fever in cases of infection…

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 Obstructive Uropathy: Presentation, Evaluation, and Management

Obstructive uropathy management depends on the etiology with emergent therapy for bilateral obstruction, an acute kidney injury, or urinary tract infection. For obstructions distal to the bladder, such as BPH, placing a foley catheter is appropriate. Coude catheters are angulated at the tip and make passage through the urethral bend in an enlarged prostate easier.

Articles of Interest

Hydronephrosis and Hydroureter

The presence of hydronephrosis or hydroureter can be physiologic or pathologic. It may be acute or chronic, unilateral or bilateral. It can be secondary to obstruction of the urinary tract, but it can also be present even without obstruction.

Medical Student Curriculum: Kidney Stones

Number of days to pass stone (mean} and % Likelihood of eventual need for intervention...2mm or less - 8days - 3%... 3mm - 12days - 14%... 4-6mm - 22days - 50%... > 6mm -- 99%...Two-thirds of ureteral stones that pass spontaneously pass within 4 weeks of the onset of symptoms.

Obstructive uropathy – acute and chronic medical management

Obstructive uropathy is a prevalent cause of acute and chronic kidney disease. Urinary tract decompression is the single most beneficial aspect of management; renal impairment is frequently reversible and the long-term renal prognosis is generally excellent. Subsequent medical care is an important but underappreciated supplement to surgical treatment.

Obstructive Uropathy: From Etiopathology to Therapy

Obstructive uropathy is responsible for a wide range of metabolic and electrolytic abnormalities that may lead to renal failure especially if the obstruction is bilateral and/or if there was a preexisting degree of renal failure. The timeframe from the occlusion of the collecting system to the development of renal impairment is shorter than we initially thought.

Obstructive uropathy: Overview of the pathogenesis, etiology and management of a prevalent cause of acute kidney injury

Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary tract. It is regarded as one of the most prevalent causes of acute kidney injury (AKI), accounting for 5%–10% of cases. Acute severe obstruction of the urinary tract is a potentially threatening situation for the kidneys and therefore requires prompt identification and management to relieve obstruction.

Radiologic Management of Urinary Tract Obstruction

Acute obstructive uropathy is a medical emergency that often is accompanied by acute renal failure or sepsis. In use for more than 60 years [1], percutaneous nephrostomy (PCN) catheter placement provides access into the renal collecting system for urinary decompression and, more recently, facilitates endourologic surgery. PCN was originally performed with limited imaging guidance, and its acceptance was therefore marginalized. Over the ensuing decades, with the improvement in catheters and interventional radiological techniques and the standard use of imaging guidance, the procedure has become increasingly safe. Over this same period, the procedure itself has been performed with increasing frequency as indications have expanded.

Resources

Radiopaedia

An obstructive uropathy is a catch-all term encompassing any cause of complete or partial, congenital or acquired, and permanent or intermittent obstruction of the urinary tract.

StatPearls

Obstructive uropathy is a hindrance to normal urinary flow that can be caused by a variety of structural and functional etiologies. This is a common and potentially serious condition that affects people across all ages and walks of life. To avoid the morbidity and mortality associated with this condition, it must be promptly diagnosed and treated.

Zero to Finals

The term obstructive uropathy refers to a blockage preventing urine flow through the ureters, bladder and urethra.