What Is Obstructive Uropathy?

Obstructive urinary tract disease is a structural or functional change in the urinary tract that prevents normal urinary flow and can sometimes cause renal insufficiency. Obstructive urinary tract diseases are common at any age. Hydronephrosis (a result of a kidney disease) was found in 4% of patients at autopsy, with the same gender distribution for men and women. Obstructive urinary tract disease is more common in men> 60 years of age because of the increased incidence of benign prostatic hyperplasia and prostate cancer.

Basic Information

Visiting department: Urology
Multiple groups: Men over 60

Common causes: Benign prostatic hyperplasia, prostate cancer, foreign body, tumor, etc.
Common symptoms: Renal insufficiency, urethral obstruction, stones, etc.

Causes of Obstructive Urinary Tract Disease

Obstructive urinary tract diseases can be classified as acute or chronic, partial or complete, and unilateral or bilateral. It can occur at any level from the renal tubules (cast, crystalline) to the outer urethra, resulting in increased intraluminal pressure, urinary stasis, urinary tract infections and stone formation.

Male urethral obstruction can be caused by benign prostatic hyperplasia, prostate cancer, chronic prostatitis with fibrosis, foreign bodies, bladder neck contraction, or congenital urethral valve. Urethral and urethral strictures can be acquired or congenital. Urinary tract obstruction is rare in women, but can occur secondary to tumors, radiation therapy, surgery or the use of urinary tract devices (usually repeated dilatation).
Obstructive nephropathy (renal insufficiency, renal failure, or tubulointerstitial damage) can be due to increased intraluminal pressure, ischemia, or urinary tract infections. Infiltration of inflammatory T cells and macrophages, autoimmune response to reflux urine Tamm-Horsfall mucin, and vasoactive hormones may also be involved in kidney damage.

The pathological manifestations were dilation of the collecting duct and distal tubules and chronic tubular atrophy, and the glomerular damage was slight. Obstructive urinary tract disease without urinary tract dilatation can occur in retroperitoneal tumors or fiber-wrapped aggregate systems; lighter lesions, no impairment of renal function, within 3 days of urinary tract obstruction; the compliance of the collective system is relatively poor and difficult to expand Obstructive urinary tract disease can occur in 2% of children, often with congenital urinary tract abnormalities.

Clinical manifestations of obstructive urinary tract disease

Unexplained renal insufficiency, benign prostatic hyperplasia or precancerous lesions or urinary stone formation. Bladder neck obstructions, such as pain on the pubic bone, the bladder can be affected or unexplained renal failure in older men, urethral obstructions, such as stenosis, valves. Renal vascular resistance increases, and Doppler ultrasound can usually diagnose unilateral urinary tract obstruction. Stones, shedding nipples, or blood clots. Functional or anatomical abnormalities with hydronephrosis.

Obstructive urinary tract disease examination

Urine test

When the infection occurs, there may be white blood cells and pus cells in the urine. There is non-specific bacterial growth in urine culture. There are red blood cells in the urine when stones are complicated.

2. Cystoscopy

For lower urinary tract obstruction, cystoscopy can reveal prostate hyperplasia, bladder neck contracture, bladder stones and trabecular, trabecular, diverticulum and other lesions in the bladder.

3. Urography

Opaque stones can appear on plain films when stones are complicated. When the upper urinary tract is obstructed, the affected side often has hydronephrosis. Severe hydronephrosis often causes renal function loss without development. Hydroureter may show dilation, tortuosity, etc. When the lower urinary tract is obstructed, the bladder chakra is irregular, and the size and location of the diverticulum can be displayed when there is diverticulum. Bladder urethral angiography can show urethral strictures and valve lesions.

4. Type B ultrasound

When the upper urinary tract is obstructed, the fluid level of the affected kidney can often be detected, suggesting that there is hydronephrosis. Stones and their sound and shadow can be explored during concurrent stones. When the lower urinary tract is obstructed, different levels of residual urine can be measured in the bladder.

5.CT scan check

In the case of upper urinary tract obstruction, in addition to measuring hydronephrosis, CT scan can also measure the thickness of the renal cortex, which is of great reference value for determining treatment options. CT scans can still detect stone shadows, and sometimes renal pelvis and ureteral tumors.

6. Renal function test

Early in the obstruction, renal function is often unchanged. Unilateral upper urinary tract obstruction often causes renal dysfunction in the affected side, which can be indicated by indigo rouge test, isotope nephrogram and intravenous urography. Long-term upper urinary tract obstruction and lower urinary tract obstruction can cause renal insufficiency on both sides, and increase in blood urea nitrogen and creatinine. Isotope nephrograms can show impaired or obstructed kidney function.

7. Urodynamic Test

In lower urinary tract obstruction, the maximum urinary flow rate is reduced (<10ml / sec), and the bladder pressure during urination is significantly increased (> 70cm water column).

Obstructive urinary tract disease diagnosis

It is not difficult to make a diagnosis based on medical history, clinical manifestations, and laboratory data.

Differential diagnosis of obstructive urinary tract disease

Prostate hypertrophy, tumor, or neurogenic urinary retention.

Obstructive urinary tract disease treatment

Most cases can be corrected, but delayed treatment can lead to irreversible kidney damage. The prognosis varies depending on the pathological conditions that cause urinary tract obstruction and the presence or absence of urinary tract infection. In general, acute renal failure caused by ureteral stones is reversible, and renal function can be fully restored. In chronic progressive obstructive urinary tract disease, renal insufficiency can be partly or irreversibly. When adequate treatment is given in time At this time, the prognosis of renal function is better.

Treatment includes medication (such as hormone therapy for prostate cancer), equipment (such as endoscope, lithotripsy), or surgery to remove the obstruction. If renal function is impaired, urinary tract infection persists or pain is noticeable, rapid drainage of hydronephrosis should be performed. For severe obstructive urinary tract diseases, urinary tract infections and stones may require temporary drainage. Percutaneous techniques can be used in most cases. Lower urinary tract obstruction may require catheter drainage or urinary diversion. In some patients, a pig tail ureteral catheter can be inserted for acute or long-term drainage. Urinary tract infections and renal failure must be actively treated.

Patients who have pain and a positive renal picture after diuresis should consider surgery. No treatment is required for asymptomatic patients with a positive renal pattern after diuresis but normal renal function or negative renal pattern after diuresis.

The treatment of urinary calculi is considered from two aspects. One is to treat the primary disease such as metabolic disorders, infection or existing anatomical factors; the other is to treat the complications of stones, namely obstruction and infection. The simplest and most effective is to drink a lot of water. Diluted urine can delay the growth of urinary stones and prevent recurrence of urinary stones. Drinking a lot of water can promote drainage when there is an infection. Changing urine pH can also prevent recurrence of stones. Cystine is more soluble in urine with a pH above 7.5. Soda and sodium citrate can alkalinize urine. Allopurinol can reduce the production of uric acid and 2,8-dihydroxyadenine orally, so it is effective for controlling the recurrence of this type of stones. Indications for previous surgery are: stones that are too large to be excreted from the urinary tract. Patients with hydronephrosis and infection that cause renal dysfunction. Severe severe pain and a lot of hematuria often occur, affecting healthy people. Acute obstructive anuria or oliguria. Those who are not effective after long-term non-surgical treatment. For ureteral calculi, acupuncture and traditional Chinese medicine are effective. In cases of severe obstruction or infection and large stones that cannot be discharged using the method, ureterolithotomy should still be considered. For smaller bladder stones, try Chinese medicine fossils and anti-infective treatment. If the stones are large, the suprapubic bladder incision and fistula should be done. Kidney stones in children can be treated by extracorporeal shock wave lithotripsy; endoscopic and percutaneous stone extraction is more limited in children.