Obstructive_Uropathy_Presentationss.pptx

Obstructive_Uropathy_Presentationss.pptx

1. Obstructive Uropathy Postgraduate Surgery Presentation

2. Definition Obstructive uropathy refers to structural or functional obstruction of urinary flow at any level of the urinary tract, leading to renal dysfunction. It may be acute or chronic, partial or complete, unilateral or bilateral.

3. Etiology Upper Tract Causes: • Calculi • Ureteric stricture • Pelviureteric junction obstruction • Tumors (renal pelvis, ureter, retroperitoneal) Lower Tract Causes: • Benign prostatic hyperplasia • Urethral stricture • Bladder neck obstruction • Posterior urethral valves • Neurogenic bladder

4. Pathophysiology Obstruction increases intraluminal pressure, causing dilation of urinary tract and compression of renal vasculature. Prolonged obstruction leads to ischemia, interstitial fibrosis, tubular atrophy, and eventual irreversible renal failure.

5. Clinical Features • Flank pain (acute obstruction) • Chronic dull ache or mass (chronic obstruction) • Oliguria or anuria (bilateral obstruction) • Recurrent urinary tract infections • Hematuria • Hypertension • Signs of uremia in chronic cases

6. Investigations • Urine analysis: Pyuria, hematuria, bacteriuria • Serum urea and creatinine • Ultrasound: Detects dilatation and obstruction level • CT urogram: Identifies cause and exact level • Diuretic renogram (MAG3/DTPA): Functional assessment • Cystoscopy or retrograde pyelography: Lower tract assessment

7. Emergency Management Indicated in cases with sepsis, anuria, or renal failure. • Relieve obstruction: - Percutaneous nephrostomy - Ureteral stenting • Correct fluid, electrolyte, and acid-base imbalance. • Treat infection with antibiotics.

8. Definitive Management Treatment depends on etiology: • Calculi → URS/PCNL or lithotripsy • PUJ obstruction → Pyeloplasty • BPH → TURP or open prostatectomy • Urethral stricture → Dilation or urethroplasty • Tumors → Resection or diversion

9. Postoperative and Long-term Care • Monitor urine output and renal function recovery. • Manage infection and electrolyte abnormalities. • Follow-up imaging to ensure drainage and renal recovery. • Chronic cases may require long-term nephrostomy or dialysis.

10. Complications • Chronic kidney disease • Hypertension • Recurrent UTIs • Pyonephrosis • Post-obstructive diuresis • Irreversible renal failure

11. Summary Obstructive uropathy requires early recognition and prompt management. Temporary decompression relieves pressure, while definitive therapy addresses the cause. Monitoring renal function and preventing infection are key to preserving renal health.