Obstruction of the Urinary System

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Obstruction of the Urinary System

• Huo Jun

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General Consideration

• Urinary system,from urnal tubules,calys,pelvis,ure
  ter bladder to urethra,is tract.Any part of tract
  obstruction can be occured.Although obstructive
  places are different.Obstrution results at last
  in hydronephrosis, renal function damage,renal
  function failure.

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1 Obstructive Causes

• mechanic or dynamic
• congenital or acquired
• medical
• ?Kidney stone tumor inflammation TB congenital
  stenosis
• ?UreterStone is very common.inflammation TB
  tumor congenital deformity of ureter.
• ?Bladder Common cause is obstruction of bladder
  neck prostatic hyperplasia fibrosis tumor
  nervous bladder
• ?Urethra urethrostenosis comes from inflammation
  ,lesion, stone, TB, tumor

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2 Pathophysiology

• Basic pathology of dilatation of urinary tract
  above obstruction
• Safety valve in kidney. Urine doesnt enter
  ureter and enter renal parenchyma.
• Vein and lymphatic vessel.
• Pathological lesion of hydronephrosis s is
  pelvic dilatation. Pelvic wall becomes thin
  renal papilla becomes atrophy and flat, renal
  parenchyma becomes atrophy and thin. Pelvic
  capacity increase. All kidney forms a
  dysfunctional huge water sac.
• II Hydronephrosis .(nephrohydrosis,
  hydronephrosis)

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1 definition

• The urine from kidney encounters obstruction,
  that results in pressure increases in kidney,
  dilatation of calyx and pelvic and atrophy of
  renal parenchyma.

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2 clinical manifestations

• Symptoms and physical sign of primitive diseases.
  Manifestation of hydronephrosis is lump in
  abdomen. Sometimes shows intermittent attack
  called intermittent hydronephrosis. Long time
  obstruction which produces hydronephrosis results
  in renal function decrease. If bilateral of
  separated kidney is obstructed , renal function
  failure.

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3 Diagnosis

• ?Be sure whether hydronephrosis exists.
• 1)      IVP The developing time of renal
  parechyma prolongs.
• 2)      RPG
• 3)      B-ultrasound distinguish hydronephrosis
  from renal tumor.
• 4)      CT-scan
• 5)      Renal scan and renal pictures of
  radioactive isotope
• ?Be sure causes, location, degree, whether
  infection, condition of renal function damage.

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?Laboratory exam

• 1)      blood exam be sure whether azotemia,
  acidosis, electrolytic disturbance.
• 2)      Urine exam
• Urine RT, urine culture, and acid-fast bacilli
  and cells.

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4 Treatment

• ?Treatment of causes
• ?Nephrotresis
• ?Nephrectomy,serious hydronephrosis or
  pyonephrosis contralateral renal function is
  abnormal .

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III Prostatic hyperplasia

• 1 Etiology
• The causes of prostatic hyperplasia is unknown.
• 2 Pathology
• ? Prostatic hyperplasia is hyperplasia of gland
  surrounding urethra.
• ? Prostatic hyperplasia results in curvature and
  extension of urethra. Urethra is pressed to
  become stenosis but urethra itself is not
  stenosis.
• ? The degree of prostatic hyperplasia is not
  related with degree of the urine obstruction, but
  is directly related with place of hyperplasia
  part.
• ? Late phase, prostatic hyperplasia produces
  bilateral hydronephrosis and damage of renal
  function

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3 Clinical manifestations

• gt50 year old late, the symptoms is present.
• ? Frequency nocturia increase is very common.
• ? Difficulty of urination
• 1)      In mild obstruction ,hesitency,
  intermittent and dribbing after urination.
• In severe obstruction, efforts of urination.
  Urinary range becomes short, urination becomes
  thin and no effort, finally results in dribbing.

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? Uroschesis

• Residual urine increase ?lose of bladder
  contraction?uroschesis increases?incontinence.
  Called filling incontinence. Acute uroschesis is
  due to sudden prostatic congestion and hydrops
  because of weather variation drinking and
  overwork.

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4 Diagnosis

• ? History and physical exam
• 1)      History
• 2)      Physical exam, after urination ,PR
• ? Other exam
• 1)        Urinary dynamic exam.
• Measure of residual urine in bladder

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5       Differential diagnosis

• ? Fibrosis of bladder neck.
• ? Prostatic cancer
• ? Cancer of bladder
• ? Neurogenic bladder
• ? Urethral stenosis

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5          Treatment

• ? Operative therapy
• Indications
• 1)      Residual urine is more than 50 ml.
• 2)      Acute uroschesis in the past.
• Severe symptoms affect normal life.

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Routes of operation

• 1)      Retropubic
• 2)      Suprapubic
• 3)      Perineal
• 4)      Transurethral
• TURP transurethral prostatectomy

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? Conservative therapy

• 1) Female hormone ethylestrenol
• 2) Paralyser of a-receptor.