Urinary tract obstruction

• What is Urinary Tract Obstruction
• Statistics on Urinary Tract Obstruction
• Risk Factors for Urinary Tract Obstruction
• Progression of Urinary Tract Obstruction
• Symptoms of Urinary Tract Obstruction
• Clinical Examination of Urinary Tract Obstruction
• How is Urinary Tract Obstruction Diagnosed?
• Prognosis of Urinary Tract Obstruction
• How is Urinary Tract Obstruction Treated?
• Urinary Tract Obstruction References

What is Urinary Tract Obstruction

A Urinary Tract Obstruction occurs in the urinary tract, this includes the renal pelvis, ureters, bladder and urethra. This condition occurs when any part of the urinary tract is obstructed, preventing the passage of urine from the kidneys to the external environment.

Statistics on Urinary Tract Obstruction

Obstruction is the most common urologic disease leading to renal failure accounting for approximately 2% of new cases. It is more common in men, largely due to prostate disease and the higher rate of urinary stones in men. Among hospital discharges in patients with kidney and urologic disorders, it is the fourth most common diagnosis in men and the sixth most common in women.

Risk Factors for Urinary Tract Obstruction

The predisposing factors for urinary tract obstruction depend on the cause of urinary tract obstruction. These include:

• Within the tract – Including calculi, blood clots, tumour.
• Within the walls of the tract – Including stricture (ureteric or urethral) and paralysed bladder,
• Pressure from outside the tract – Including enlarged prostate, pelvic tumours, and penile foreskin problems. The list of predisposing factors for these conditions is extensive. Predisposing factors common to man yof these conditions include a family history of the condition, previous urinary tract and renal disease, current renal disease and past and present malignancy.

 

Progression of Urinary Tract Obstruction

The course of urinary tract obstruction depends on the cause and completeness of obstruction. Complete urinary tract obstruction will lead to renal failure, as the kidney continues to produce urine behind the obstructing mass. Intermittent or incomplete obstruction may not cause any ill effects, unless complicated with infection. In the presence of urinary tract obstruction, the likelihood of infection is increased and the consequences more severe.

How is Urinary Tract Obstruction Diagnosed?

General investigation of urinary tract obstruction focuses on the effect of the obstruction of the function of the kidneys and urinary tract. Urine samples will be taken to detect the presence of infection and bleeding within the urinary tract. Blood tests will also be taken to assess the function of the kidneys in the presence of urinary tract obstruction.

Prognosis of Urinary Tract Obstruction

The prognosis of this condition depends upon the completeness and reversibility of the obstruction. If the obstruction cannot be reversed by surgical means, the patient will undoubtedly develop renal failure. With early reversal, the patient will retain good renal function, the loss of which being dependent on the duration of urinary tract obstruction.

How is Urinary Tract Obstruction Treated?

The treatment of urinary tract obstruction depends on the position of the obstruction – upper or lower urinary tract. 1. Lower urinary tract: In the short term, obstruction can usually be relieved with the passage of a urinary catheter into the patients bladder, pushing past the obstruction. Following this, the cause of the obstruction can then be identified and treated. Prostate disease can be treated with medication and surgery, whereas chronic bladder problems may require long-term use of catheters to ensure the bladder is emptied regularly. 2. Upper urinary tract: Depending on the severity, the accumulated urine behind the obstruction may need surgical drainage. The condition is then carefully evaluated to determine the most apporpriate form of therapy. This most often involves the use of surgiucal technique to remove the obstruction and restore the patency of the urinary tract.

Urinary Tract Obstruction References

[1] Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison’s Principles of Internal Medicine. 15th Edition. McGraw-Hill. 2001 [2] Cotran, Kumar, Collins 6th edition. Robbins Pathologic Basis of Disease. WB Saunders Company. 1999. [3] Haslet C, Chiliers ER, Boon NA, Colledge NR. Principles and Practice of Medicine. Churchill Livingstone 2002. [4] Hurst JW (Editor-in-chief). Medicine for the practicing physician. 4th edition Appleton and Lange 1996. [5] Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002 Pg 427-430. [6] Longmore M, Wilkinson I, Torok E. OXFORD HANDBOOK OF CLINICAL MEDICINE. Oxford Universtiy Press. 2001 [7] McLatchie G and LEaper DJ (editors). Oxford Handbook of Clinical Surgery 2nd Edition. Oxford University Press 2002. [8] Raftery AT Churchill’s pocketbook of Surgery. Churchill Livingsone 2001.