Obstructive Uropathy

2. Dr. ORJI DAVID ONOCHIE
Obstructive U ropathy
ropathy

3. PRESENTER
SUPERVISORS
Dr. Igbokwe Martins, MB.ChB, FMCS, FWACS
Consultant Urologist / Transplant Surgeon
Zenith Medical and Kidney Center
Dr. Orji David Onochie, MD, MPH, MCh (Urol)
Medical Officer (Surgery)
Zenith Medical and Kidney Center
Dr. Onwuasoanya Uzodimma, MBBS, FWACS
Consultant Urologist / Transplant Surgeon
Zenith Medical and Kidney Center
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4. CONTENTS
Brief Introduction
Etiology
Diagnosis
Complications
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Management
Classification

5. Brief Introduction
● Obstructive uropathy is structural or functional
hindrance of normal urine flow, sometimes leading to
renal dysfunction (obstructive nephropathy).
● Anatomically, the urinary tract is divided into the Upper
Tract (Kidney and Ureter) and the Lower Tract - Bladder
and Urethra.
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7. Epidemiology of Obstructive Uropathy
● Urinary obstruction affects all age groups, but the majority of cases present
in the bimodal distribution in infants and the elderly.
● Congenital genitourinary tract abnormalities (e.g., posterior urethral valves)
present in childhood as urinary obstruction, producing an estimate of
approximately 4% of the total cases.
● The largest group is made up of people over 60 and more frequently males
due to the anatomic presence of prostate (benign prostatic hyperplasia and
cancers).
● Obstructive uropathy is significantly less common in females.
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8. Classification of Obstructive Uropathy
● Onset
- Acute - Chronic
● Site
- Unilateral - Bilateral
● Degree
- Complete - Partial
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9. Etiology of Obstructive Uropathy
1. Intraluminal
Calculi, Tumors, Sloughed renal papilla, blood
clots, foreign body
2. Intramural
PUJ / Vesicoureteric obstruction, Urethral
strictures / Valves, Inflammation, Neuromuscular
dysfunction
3. Extramural
Gravid uterus, Retroperitoneal fibrosis,
Tumors, Prostatic enlargement, carcinoma,
prostatitis, Trauma
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10. Common Causes of Obstructive Uropathy
1. Upper Urinary Tract (Kidneys and Ureter)
- Calculi
2. Lower Urinary Tract (Bladder and Urethra)
- Benign prostatic hyperplasia (BPH), Prostate cancer, Strictures,
Posterior urethral valves.
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11. 11
STENOSIS IN THE
URETEROPELVIC
JUNCTION

12. Diagnosis of Obstructive Uropathy
Concise
history taking
Laboratory
Investigation
Presentation +/-
Acute Intervention
Physical
Examination
Radiological
Investigation
Diagnostic /
Therapeutic Surgical
Intervention
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13. Clinical Presentation of Obstructive Uropathy
Symptoms
The severity of symptoms and likely even the number of symptoms
present are influenced by the degree, location, and time from the onset
of the obstruction.
- Voiding LUTS (Frequency, Hesitancy, Poor stream, dribbling)
- Sudden onset of abdominal pain
- Colicky flank pain that radiates to the groin
- Hematuria
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14. Clinical Presentation of Obstructive Uropathy
Complications
- Septicaemia
- Pyonephrosis
- Nephropathy
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15. Clinical Presentation of Obstructive Uropathy
History
- Recent surgeries (e.g., appendectomy, hysterectomy)
- Previous hx of instrumentation, catheterization
- Previous hx of UTIs and STDs
- Congenital anomalies
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16. Clinical Presentation of Obstructive Uropathy
Physical Examination
A complete examination should be performed, focusing on the abdomen
and genitalia.
- Inspection - Scars, Abdominal distension, Pedal Edema
- Palpation - Distended bladder, Ballotable Kidneys, Masses
- Digital Rectal Exam - Prostate
- Bimanual Examination - Bladder masses
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19. Laboratory Investigations
● Urinalysis
- Infection - Haematuria
● Basic metabolic panel
- BUN - Creatinine
● Full Blood Count
- Anaemia - Sepsis
● Prostate Specific Antigen
- BPH - Prostate CA
Diagnosis of Obstructive Uropathy
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20. Radiological Investigations
● Ultrasonography
- Noninvasive, inexpensive, ideal for pregnant individuals.
● Computed tomography
- Non-Contrast (CT KUB) - Contrast (CT IVU)
● Magnetic resonance imaging
● Radionucleotide studies
● Retrograde urethrography
● Nephrostography
Diagnosis of Obstructive Uropathy
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Axial CT images with intravenous contrast, revealing right-sided hydronephrosis
(left image) and an obstructing right ureteropelvic junction stone (right image).

25. 25
Retrograde urethrogram
displaying complete obstruction
of prostatic urethra.
Kidney-ureter-bladder (KUB) image
displaying a large right-sided renal
stone and an indwelling ureteral stent.

26. Diagnostic Procedures
● Urethrocystoscopy
● Cystoscopy with retrograde pyelography
● Ureteroscopy
Diagnosis of Obstructive Uropathy
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27. The following cases require an Urgent Consult to the Urologist:
● Complete urinary tract obstruction
● Any type of obstruction in a solitary kidney
● Obstruction with fever and/or infection.
● Bilateral stones.
● Transplanted kidney.
● Kidney failure*
● Any suspicion of neurological dysfunction*.
● Uncontrolled pain*.
● Nausea and vomiting sufficient to cause dehydration*.
*associated with urinary tract obstruction
Management of Obstructive Uropathy
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28. Management of Obstructive Uropathy
Surgical
Intervention
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Long Term
Management
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Acute
Care
1
Medical
Therapy.
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29. Acute Care
● Urethral Catheterization
● Suprapubic Catheterization
● Analgesics
● Percutaneous Nephrostomy
Management of Obstructive Uropathy
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30. Medical Therapy
● Analgesics
● Antibiotics (e.g Trimethoprim)
● Selective alpha-1 adrenergic receptor antagonists (e.g Tamsulosin)
Management of Obstructive Uropathy
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31. Surgical Intervention
● Transurethral Resection of the Prostate (TURP / cTURP)
● Open / Prostatectomy
● Ureteral Stenting
● Laser Lithotripsy
● Open / Laparoscopic Pyeloplasty
● Percutaneous Nephrostomy/Nephrolithotomy (PCNL)
Management of Obstructive Uropathy
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35. Long Term Management
● Follow up clinic
● Follow up Investigations
● Follow up Imaging
Management of Obstructive Uropathy
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36. References
● Rishor-Olney CR, Hinson MR. Obstructive Uropathy. [Updated 2022 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558921/
● Meldrum KK. Pathophysiology of urinary tract obstruction. Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-
Walsh Urology. 11th ed. Philadephia, Pa: Elsevier; 2016. 1089-1103
● Lefort C, Marouteau-Pasquier N, Pesquet AS, Pfister C, Vera P, Dacher JN. Dynamic MR urography in urinary tract
obstruction: implementation and preliminary results. Abdom Imaging. 2006 Mar-Apr. 31(2):232-40.
● Thomas AW, Cannon A, Bartlett E, et al. The natural history of lower urinary tract dysfunction in men: minimum 10-year
urodynamic follow-up of untreated bladder outlet obstruction. BJU Int. 2005 Dec. 96(9):1301-6.
● McAleer IM, Kaplan GW, LoSasso BE; Congenital urinary tract anomalies in pediatric renal trauma patients. J Urol. 2002
Oct168(4 Pt 2):1808-10
● Abdul-Rahman A, Al-Hayek S, Belal M. Urodynamic studies in the evaluation of the older man with lower urinary tract
symptoms: when, which ones, and what to do with the results. Ther Adv Urol. 2010 Oct. 2(5-06):187-94.
● Tonni G, Vito I, Ventura A, et al; Fetal lower urinary tract obstruction and its management. Arch Gynecol Obstet. 2012 Nov
9.
● Naderi N, Mochtar CA, de la Rosette JJ; Real life practice in the management of benign prostatic hyperplasia. Curr Opin
Urol. 2004 Jan14(1):41-4.
● de Bessa J Jr, Rodrigues CM, Chammas MC, Miranda EP, Gomes CM, Moscardi PR, et al. Diagnostic accuracy of Onen's
Alternative Grading System combined with Doppler evaluation of ureteral jets as an alternative in the diagnosis of
obstructive hydronephrosis in children. PeerJ. 2018. 6:e4791.
● Bertrand LA, Warren GJ, Voelzke BB, Elliott SP, Myers JB, McClung CD, et al. Lower urinary tract pain and anterior
urethral stricture disease: prevalence and effects of urethral reconstruction. J Urol. 2015 Jan. 193 (1):184-9.
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