OBSTRUCTIVE

UROPATHY

Structural & functional with normal urine flow

along the urinary tract, from renal tubule to the urethra.
The resultant increased pressure , proximal to the
obstruction hydronephrosis, dilatation of calyxes &
renal pelvis anatomic outcome that affect collecting
system, distal to the renal pelvis.
Hydroureter, often accompany hydronephrosis, if
obstruction is distal to the ureteropevic junction

 In USA 400,000 px hospitalized

Hydronephrosis : 3 % with men & women ,
equal
Strictures of urethra & ureter, causes of obst. at
autopsy in px of 10 yrs or <
In women of 20 60 yrs, due to pregnancy &
gynecologic Ca.
In males, of 60 yrs BPH

 Recognition of U.Obst. is very important , since

U.Obst. increases susceptibility to infection & to
stone formation & unrelieved obstr.
permanent renal atrophy ( hydronephrosis )
Medically or surgically correctable
It can be partial or complete ; unilateral or
bilateral;
Lesions, intrinsic or extrinsic

Classification & Clinical & Lab.

manifestation

Often classified on the basis of duration, location

& degree of obst. process.
Duration : * acute ( hrs days)
* subacute ( days weeks)
* chronic ( months yrs )
Location, anywhere from renal tubule to urethral
meatus unilateral or bilateral of collect. syst.
Degree : * partial or
* complete

 Clinical presentation
- acute obst. abrupt pain
- If process is unilateral , at the level of renal
pelvis or ureter severe flank pain, often
described as colicky when due to intraluminal
process, such as nephrolithiasis or pap.
necrosis.
- Occurs at the level of bladder outlet
suprapubic pain & fullness ; may be
accompanied by freq. & urgency

 Phys. Exam. : HT, flank pain on percussion or

suprapubic mass. in px with outlet obst.
Lab. Manifestation :
- unilat. obstr. limited to abn. of urinalysis
- intrinsic fom of obstr. mic. / gross hematuria
- with intrinsic or extrinsicsec.inf. pyuria &
bacteriuria.
- bilat. Obstr. lab.findings = ARF
see pictures

 ETIOLOGY :
Acquired intrinsic :
* Leading to obstr. : intraluminal & intramural
* Intraluminal obstr. due to renal tubular obstr.
( otherwise called intrarenal obstr. )
* e.g. - ARF in multiple myeloma
- tumor lysis syndrome ( due to
chemotherapy in lympoma
precipitation of uric acid crystal
- drugs : sulfadiazin, sulfamethoxazole,
ciprofloxacin, cephalexin, ampicillin,
acyclovir etc.

* extrarenal causes : nephrolithiasis

* pap. Necrosis, ureteral obstr., seen in
sickle cell disease, DM, amyloidosis,
analgesic abuse
* Intramural obstr. : anatomic & functional
- Anatomic : tumor& stricture , transitionalcell Ca. of the renal pelvis & ureter
- Ureter or urethral strictures may result from
infection, trauma, postradiation tx ;
Schistosomiasis

- Functional : neuromuscular abn.

obstr.alt. normal dynamic response
Multiple Sclerosis

Acquired Extrinsic :
* Most common : pregnancy ureteral
dilatation.
* Ca Cervix Uteri
* Older women : prolaps uteri hydronephr.
* Endometriosis
* PID & Tuboovarial abscess

 In men : BPH, Adeno Ca Prostat, Colorectal Ca

UROLITHIASIS

In USA : 5 10 % population
Men > women : 20 30 yrs of age
Hereditary : inborn errors of metabolism
4 main types of calculi :
* 70% Ca, Ca Oxalat or Ca OX + Ca Phos.
* 15% Triple stone
* 5 10 % uric acid
* 1 2% cystine

 Stone formation : increased urinary

concentration of stone constituents,exceeds
their solubility in urine ( supersaturation )
Ca Oxalat stone : 5% of px with hypercalcemia &
hypercalciuria ( caused by hyperparathyroid,
bone disease, sarcoidosis )
20% Ca Ox, stone associated with incr, uric acid
secr)
Mg Am Ph. Stone, formed after infection by urea
splitting bacteria(e,g, Proteus ), which convert
urea to ammoniaprecipitationstaghorn
calculi

Uric acid stone :

Common in px with hyperuremia
> 50% have neither hyperurecemia nor
increased urinary excr, of uric acid.
Cystine stone, caused by genetic defect in the
renal re-abs, of amino acid, incl. cystin
cystinuria; formed at low pH
Stone formation depends on : pH, decreased
urine vol, & infection