Obstructive uropathy

Obstructive uropathy is a structural or functional hindrance of normal urine flow,[1] sometimes leading to renal dysfunction (obstructive nephropathy).

Obstructive uropathy
SpecialtyUrology 

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, nocturia, or polyuria.

Causes

It can be caused by a lesion at any point in the urinary tract.[2]

Causes include urolithiasis,[3] posterior urethral valves and ureteral herniation.[3]

Diagnosis

Diagnosis is based on results of bladder catheterization, ultrasonography, CT scan, cystourethroscopy, or pyelography, depending on the level of obstruction.

Treatment

Treatment, depending on cause, may require prompt drainage of the bladder via catheterization, medical instrumentation, surgery (e.g., endoscopy, lithotripsy), hormonal therapy, 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:[4] dilatation with cutting balloon catheter followed by introduction of the pyeloplasty balloon catheter.[5] 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 heals. Urine can drain through the central channel of this catheter.

References
  1. Definition: obstructive uropathy from Online Medical Dictionary.
  2. Kumar, Vinay; Fausto, Nelson; Fausto, Nelso; Robbins, Stanley L.; Abbas, Abul K.; Cotran, Ramzi S. (2005). Robbins and Cotran Pathologic Basis of Disease (7th ed.). Philadelphia, Pa.: Elsevier Saunders. p. 1012. ISBN 978-0-7216-0187-8.
  3. Tsai PJ, Lin JT, Wu TT, Tsai CC (September 2008). "Ureterosciatic hernia causes obstructive uropathy". J Chin Med Assoc. 71 (9): 491–3. doi:10.1016/S1726-4901(08)70155-2. PMID 18818145.
  4. Treatment of ureteropelvic junction obstruction using a detachable inflatable stent: initial experience Archived 2014-01-09 at the Wayback Machine by Timotheus T C Overtoom, Peter L Vijverberg, Hendrik W van Es, Sandrine van Selm, Hans P M van Heesewijk
  5. "Overtoom balloon". www.overtoomballoon.com. Retrieved 2016-10-15.
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