Obstructive uropathy is a structural or functional hindrance of normal
urine
Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excreted from the body through the urethra.
Cellular ...
flow, sometimes leading to renal dysfunction (obstructive
nephropathy
Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can b ...
).
It is a very broad term, and does not imply a location or cause.
Presentation
Symptoms, less likely in chronic obstruction, are pain radiating to the T11 to T12
dermatomes,
anuria
Anuria is nonpassage of urine, in practice is defined as passage of less than 100Harrison's Principles of Internal Medicine, 19E PAGE 292 milliliters of urine in a day. Anuria is often caused by failure in the function of kidneys. It may also occu ...
,
nocturia
Nocturia is defined by the International Continence Society (ICS) as “the complaint that the individual has to wake at night one or more times for voiding (''i.e. to urinate'').” The term is derived from Latin ''nox, night'', and Greek '' α ...
, or
polyuria
Polyuria () is excessive or an abnormally large production or passage of urine (greater than 2.5 L or 3 L over 24 hours in adults). Increased production and passage of urine may also be termed diuresis. Polyuria often appears in conjunction wit ...
.
Causes
It can be caused by a lesion at any point in the
urinary tract
The urinary system, also known as the urinary tract or renal system, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, c ...
.
Causes include
urolithiasis
Kidney stone disease, also known as nephrolithiasis or urolithiasis, is a crystallopathy where a solid piece of material (kidney stone) develops in the urinary tract. Kidney stones typically form in the kidney and leave the body in the urine ...
,
[ ] posterior urethral valves and ureteral herniation.
Diagnosis
Diagnosis is based on results of bladder
catheterization,
ultrasonography
Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies fr ...
,
CT scan,
cystourethroscopy, or
pyelography, depending on the level of obstruction.
Treatment
Treatment, depending on cause, may require prompt drainage of the
bladder
The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...
via
catheterization, medical instrumentation, surgery (e.g.,
endoscopy
An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inse ...
,
lithotripsy
Lithotripsy is a non-invasive procedure involving the physical destruction of hardened masses like kidney stones, bezoars or gallstones. The term is derived from the Greek words meaning "breaking (or pulverizing) stones" ( litho- + τρίψω r ...
),
hormonal therapy
Hormone therapy or hormonal therapy is the use of hormones in medical treatment. Treatment with hormone antagonists may also be referred to as hormonal therapy or antihormone therapy. The most general classes of hormone therapy are oncologic horm ...
, or a combination of these modalities.
Treatment of the obstruction at the level of the ureter:
:* Open surgery.
:* Less invasive treatment: laparoscopic correction.
:* Minimal invasive treatment: Overtoom procedure: dilatation with cutting
balloon catheter
A balloon catheter is a type of "soft" catheter with an inflatable "balloon" at its tip which is used during a catheterization procedure to enlarge a narrow opening or passage within the body. The deflated balloon catheter is positioned, then in ...
followed by introduction of the
pyeloplasty balloon catheter.
This balloon is inflated with pure contrast agent via the pusher and remains in situ in the ureter to keep the previous treated stricture dilated while the expanded
urothelium
Transitional epithelium also known as urothelium is a type of stratified epithelium. Transitional epithelium is a type of tissue that changes shape in response to stretching (stretchable epithelium). The transitional epithelium usually appears ...
heals. Urine can drain through the central channel of this catheter.
References
External links
{{Urinary tract disease
Urological conditions