Obstructive Uropathy

OBSTRUCTIVE UROPATHY

INTRODUCTION:

Obstructive uropathy refers to the impairment of  renal function as a result of obstruction of the urinary tract.  Obstructive uropathy should be avoided as this is a reversible cause of kidney failure.

CAUSES OF OBSTRUCTIVE UROPATHY:

Obstructive uropathy can be due to obstruction of the urinary tract at any part but typically in the tubular part, namely, the ureter and the urethra. 

The causes of ureteric obstruction may include intraluminal causes, e.g. a stone or extraluminal causes e.g. enlarged lymph nodes or pelvic organs e.g. the uterus, cancer cervix.

The causes of bladder outlet obstruction could include enlarged prostate, urethral stricture or occasionally a urethral stone. 

Diagram urinary tract:

DIAGNOSIS:

Diagnosis of the obstructive uropathy would involve uro-radiology, namely, KUB, ultrasound, CT and CT scan. When intravenous contrast cannot be used, a MRI may occasionally be done without contrast to delineate the urinary tract better.  Ureterography, percutaneous or retrograde, can also be done.

TREATMENT:

The treatment of obstructive uropathy depends on the underlying cause. If the underlying cause is due to a stone, the stone will need to be removed as a matter of urgency. If it is due to an underlying malignancy, e.g. a lymphoma, cancer cervix, iatrogenic ureteric injuries, this has to be treated in an appropriate manner. 

The kidney can be drained, e.g. with a drainage tube. This may be an external drain, e.g. a percutaneous nephrostomy inserted under ultrasound and fluoroscopic guide.  if the patient is well enough to go to operating theatre, it may be possible to insert an indwelling ureteric stent. 

Written by:

Dr Clarence Lei Chang Moh, FRCS Urol, FEBU

Consultant Urologist

email: clarencelei@gmail.com

4 Sept 2013