Obstructive uropathy

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Obstructive uropathy
Classification and external resources
ICD-10 N13
ICD-9 599.60
MedlinePlus 000507
eMedicine radio/804

Obstructive uropathy is a structural or functional hindrance of normal urine flow,[1] sometimes leading to renal dysfunction (obstructive nephropathy).

It is a very broad term, and does not imply a location or etiology.

Causes[edit]

It can be caused by a lesion at any point in the urinary tract.[2]

Causes include urolithiasis,[3] posterior urethral valves and ureteral herniation.[3]

Symptoms[edit]

Symptoms, less likely in chronic obstruction, are pain radiating to the T11 to T12 dermatomes, anuria, nocturia, or polyuria.

Diagnosis[edit]

Diagnosis is based on results of bladder catheterization, ultrasonography, CT scan, cystourethroscopy, or pyelography, depending on the level of obstruction.

Treatment[edit]

Treatment, depending on cause, may require prompt drainage of the bladder via catheterization, medical instrumentation, surgery (e.g. endoscopy, lithotripsy), hormonal therapy, or a combination of these modalities.

Treatment of the obstruction at the level of the ureter:

  • Open surgery.
  • Less invasive treatment: laparoscopic correction.
  • Minimal invasive treament: Overtoom procedure:[4] dilatation with cutting balloon catheter (e.g. Boston Scientific) followed by introduction of the pyeloplasty balloon catheter.[5] This balloon is inflated with pure contrast agent via the pusher and remains in situ in the ureter to keep the previous treated stricture dilated while the expanded urothelium heals. Urine can drain through the central channel of this catheter.

References[edit]

  1. ^ Definition: obstructive uropathy from Online Medical Dictionary.
  2. ^ Kumar, Vinay; Fausto, Nelson; Fausto, Nelso; Robbins, Stanley L.; Abbas, Abul K.; Cotran, Ramzi S. (2005). Robbins and Cotran Pathologic Basis of Disease (7th ed.). Philadelphia, Pa.: Elsevier Saunders. p. 1012. ISBN 0-7216-0187-1. 
  3. ^ a b Tsai PJ, Lin JT, Wu TT, Tsai CC (September 2008). "Ureterosciatic hernia causes obstructive uropathy". J Chin Med Assoc 71 (9): 491–3. doi:10.1016/S1726-4901(08)70155-2. PMID 18818145. [dead link]
  4. ^ Treatment of ureteropelvic junction obstruction using a detachable inflatable stent: initial experience by Timotheus T C Overtoom, Peter L Vijverberg, Hendrik W van Es, Sandrine van Selm, Hans P M van Heesewijk
  5. ^ Pyeloplasty balloon catheter