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Obstruction of the Urinary System

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Urinary system,from urnal tubules,calys,pelvis,ureter bladder to urethra,is ... increases in kidney, dilatation of calyx and pelvic and atrophy of renal parenchyma. ... – PowerPoint PPT presentation

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Title: Obstruction of the Urinary System


1
Obstruction of the Urinary System
  • Huo Jun

2
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.

3
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

4
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)

5
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.

6
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.

7
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.

8
?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.

9
4 Treatment
  • ?Treatment of causes
  • ?Nephrotresis
  • ?Nephrectomy,serious hydronephrosis or
    pyonephrosis contralateral renal function is
    abnormal .

10
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

11
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.

12
? 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.

13
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

14
5       Differential diagnosis
  • ? Fibrosis of bladder neck.
  • ? Prostatic cancer
  • ? Cancer of bladder
  • ? Neurogenic bladder
  • ? Urethral stenosis

15
5          Treatment
  • ? Operative therapy
  • Indications
  • 1)      Residual urine is more than 50 ml.
  • 2)      Acute uroschesis in the past.
  • Severe symptoms affect normal life.

16
Routes of operation
  • 1)      Retropubic
  • 2)      Suprapubic
  • 3)      Perineal
  • 4)      Transurethral
  • TURP transurethral prostatectomy

17
? Conservative therapy
  • 1) Female hormone ethylestrenol
  • 2) Paralyser of a-receptor.
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