Urinary tract obstruction

Introduction Any part of the urinary system causes a complete or partial, acute or chronic obstruction of the lumen due to internal or external luminal causes. If the obstruction of each part is not released in time, it will eventually lead to hydronephrosis and impair kidney function. In the upper urinary system is renal pelvis, ureteral obstruction, hydronephrosis develops rapidly, but often one side is damaged; in the lower urinary system is bladder, urethral obstruction, because of the bladder as a buffer, kidney damage develops slowly, but often bilateral Kidney damage.

Cause

Urinary obstruction is caused by mechanical causes. But it can also be a functional disorder. In children should pay more attention to congenital lesions. Adults are often stones, tumors, injuries, tuberculosis, etc. The most common obstruction in older men is prostate hyperplasia. Most women are associated with pelvic lesions. Check the nerve system for neurological damage, stressful conditions, and trauma can cause obstruction.

an examination

Related inspection

Renal function test urethral examination urethral secretion examination

Urinary X-ray examination, ultrasound scan may find the extent and location of the cause and obstruction. CT and magnetic resonance examinations are performed when necessary. Treatment should be considered based on the cause and general condition of the patient. Pediatric functional obstruction can be observed waiting. Defining the cause should relieve the cause and keep the urinary system open. If the cause can not be relieved, in case of emergency, the obstruction can be made above the obstruction, and the urine can be drained to reduce the damage of the kidney.

Differential diagnosis

(A) clinical manifestations: the clinical manifestations of upper urinary tract obstruction are affected side of low back pain. When the hydronephrosis is obvious, the upper abdomen can touch the mass. If it is intermittent obstruction, the mass is large and small. When there is an infection, there may be fever, pyuria, and some symptoms such as frequent urination and urgency. Hematuria can occur when stones are complicated. Chronic renal insufficiency can occur in both sides of severe hydronephrosis, such as loss of appetite, nausea, vomiting and anemia. There is no urine in the bilateral upper urinary tract obstruction. The clinical manifestations of lower urinary tract obstruction are mainly due to progressive urinary dysfunction, which is characterized by small urinary tract, urinary inability to urinate, urinary drip, endless urination, and then urinary retention and filling urinary incontinence. Long-term urinary tract obstruction can also lead to bilateral hydronephrosis and renal insufficiency.

(B) urine test: in the case of concurrent infection, there may be white blood cells and pus cells in the urine. Mid-urin culture has non-specific bacterial growth. There are red blood cells in the urine when the stones are complicated.

(C) cystoscopy: lower urinary tract obstruction, cystoscopy can be found in prostate hyperplasia, bladder neck contracture, bladder stones and bladder trabeculae, small chamber, diverticulum and other diseases.

(4) urography: When the stones are concomitant, the opaque stones can be displayed on the flat sheet. When the upper urinary tract is obstructed, there is often hydronephrosis on the affected side. Severe hydronephrosis often leads to loss of renal function without development. Hydronephrosis can show enlargement, distortion, etc. In the case of lower urinary tract obstruction, the bladder corridor is irregular, and the size and location of the diverticulum can be displayed when there is a diverticulum. Bladder urethrography can show lesions such as urethral stricture and valvular disease.

(5) B-mode ultrasound examination: When the upper urinary tract obstruction, the affected side kidney can often find the liquid level segment, suggesting that there is hydronephrosis. Stones and their sound and shadow can be explored when stones are concomitant. When the lower urinary tract is obstructed, different degrees of residual urine can be measured in the bladder.

(6) CT scan examination: When the upper urinary tract obstruction is performed, the CT scan can measure the thickness of the renal cortex in addition to the hydronephrosis, which has important reference value for determining the treatment plan. CT scans can still detect calculi, and sometimes pelvic and ureteral tumors can be found.

(7) Renal function test: early obstruction, renal function often does not change. Unilateral upper urinary tract obstruction often leads to renal dysfunction in the affected side, which can be prompted by the rouge test, isotope kidney diagram and intravenous urography. Long-term upper urinary tract obstruction and lower urinary tract hard obstruction can cause renal insufficiency on both sides, blood urea nitrogen and creatinine increase. The isotope kidney map can show impaired renal function or obstructive kidney map.

(8) Urodynamic examination: When the lower urinary tract obstruction, the maximum urinary flow rate decreased (<10 ml/sec), and the intravesical pressure during urination was significantly increased (> 70 cm water column).

Urinary X-ray examination, ultrasound scan may find the extent and location of the cause and obstruction. CT and magnetic resonance examinations are performed when necessary. Treatment should be considered based on the cause and general condition of the patient. Pediatric functional obstruction can be observed waiting. Defining the cause should relieve the cause and keep the urinary system open. If the cause can not be relieved, in case of emergency, the obstruction can be made above the obstruction, and the urine can be drained to reduce the damage of the kidney.

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