![Page 1: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/1.jpg)
Obstructive Uropathy
Dept. Of Urology. shanghai Renji Hospital
WANG YIXIN
![Page 2: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/2.jpg)
General Conception
Stone
Obstruction
Infection Renal function1.Obstruction eventually Leads to decompensation of the mus
cular conduits and reservoirs,back pressure,and atrophy of renal parenchyma.
2.It also invites infection and stone formation.
![Page 3: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/3.jpg)
Pathologic consequences:
infravesical• Level of obstruction
supravesical
complete• Degree of obstruction
partial• Nature of obstruction infection,injury,stone,
tumor……
• Duration of obstruction
![Page 4: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/4.jpg)
The conseqences include
• Incresed intraluminal pressure
• urinary stasis
• infection
• stone formation
• loss of renal function
![Page 5: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/5.jpg)
Etiology
Congenital• meatal stenosis• ureteral strictures• posterior urethral strictures• ureterovesical junction obstr
uction
ureteropelvic junction obstruction
(various causes)• neurologic deficites
Acguired• urethral strictures inflammatory or traumatic• bladder outlet obstruction (BPH or PCA)
• vesical tumor• neuroginec bladder• extrinsic ureteral compression• ureteral or pelvic stones, strict
ures and tumor
![Page 6: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/6.jpg)
The causes of hydrocalycosis
![Page 7: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/7.jpg)
The causes of hydronephrosis
![Page 8: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/8.jpg)
Pathogenesis (patholophysiology)1
The changes in the various segments in the urinary tract, depending on the obstructive severity and duration
1. Urethral changes: dilatation, diverticulum
2. Vesical changes: trabeculation, residual urine,
diverticula
3. Ureteral changes: distention, dilatation and lengthening
![Page 9: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/9.jpg)
![Page 10: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/10.jpg)
![Page 11: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/11.jpg)
Pathogenesis (patholophysiology)2
4. Pelvicalyceal changes: first shows evidence of hyperactivity and hypertrophy and then progressive dilatation and stony,rounding of the fornices ,followed by flattening of the papillae and finally clubbing of the minor calyces.
5. Renal Parenchymal Changes:compression, ischemic atrophy.
![Page 12: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/12.jpg)
The result of renal pelvis-obstruction
![Page 13: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/13.jpg)
Clinical findings
1.Symptoms and signs:
infravesical obstruction :difficulty of voiding,weak stream ,diminished flow rate,terminal dribbling,burning ,frequency.
Supravesical obstruction :renal pain or renal colic,if gradually--asymptomatic or enlarged kidney.
![Page 14: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/14.jpg)
Clinical findings
2.Laboratory findings•Urinary infection
•Hematuria or Crystalluria
•Impaired kidney function
elevated blood urea nitrogen
and serum creatinine .
![Page 15: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/15.jpg)
Clinical findings
3.X-Ray findings
I.V.P , RGP , Ureterograms , Urefhrogram :
• localizing the site of obstruction
• demonstrate the extent of the obstructed segment
• anatomic changes
• functional changes
![Page 16: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/16.jpg)
Clinical findings
4.Special Examination
Instrumental calibration of sites of obstruction is also valuable
• isotope renography
• ultrasonic examination shows hydronephrosis and residual urine
• urineflow rate
• CT.
![Page 17: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/17.jpg)
Treatment
1.bladder drainage by a catheter
2.urethral stricture can be dilatated or urethrotomy or urethroplasty
3.urethral valves must be ruptured
4.BPH or obstructing bladder tumors require surgical removal
5.impacted stones must be removed
![Page 18: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/18.jpg)
Treatment
6.ureteral or ureteropalvic obstruction requires surgical revision and plastic repair
• ureterovesicoplasty
• ureterolithotomy
• ureteroureteral anastomosis
• bladder flaps to bridge a gap in the lower ureter
• transureteroureteral anastomosis
• ureteropyeloplasty
![Page 19: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/19.jpg)
Treatment
Preliminary drainage above the obstruction is sometimes needed to improve kidney function.
Occasionally, permanent drainage and diversion by cutaneous ureterostomy, ileal or colonic loop diversion, or permanent nephrostomy are required.
![Page 20: Obstructive Uropathy Dept. Of Urology. shanghai Renji Hospital WANG YIXIN](https://reader035.vdocuments.us/reader035/viewer/2022062518/56649ee85503460f94bfa2f8/html5/thumbnails/20.jpg)
Prognosis
The prognosis depends on the cause, site, duration, and degree of kidney demage and renal decompensation. In general, relief of obstruction leads to improvement in kidneys,especially those destroyed by inflammatory scarring.