URINARY OBSTRUCTION

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URINARY OBSTRUCTION

• By Beverly Sorreta

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ETIOLOGY

• A urinary obstruction means the normal flow of
  urine is blocked. As the urine backs up, it can
  cause infections in the urinary system, damage
  the bladder and affect the kidneys. If the
  kidneys are injured (a condition called
  hydronephrosis) it can be life threatening.

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• Obstruction may lead to alterations in blood
  chemistry infection that thrives as a result of
  urine stasis ischemia due to compression or
  atrophy of renal tissue

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CLINICAL MANIFESTATIONS

• The cause in children may be a birth defect. In
  children or adults, the urine may be blocked due
  to scarring along the urinary tract due to injury
  or infection. In adults, the most common cause is
  a kidney stone (renal lithiasis). With men, as
  they age, the most common cause is an enlarged
  prostate gland. Other causes include tumors,
  cancers and pregnancy.

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• The obstruction can involve one or both kidneys,
  called unilateral or bilateral obstruction. The
  blockage may be complete or partial. It can occur
  suddenly (acute) or develop over time (chronic).
  It varies by location.

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UNILATERAL OBSTRUCTION
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Signs and symptoms

• inability to pass urine (urinary retention)
• weak stream of urine
• interrupted stream
• blood in the urine
• pain in either flank (side) or in the back
• abdominal pain and/or swelling

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LABS AND DIAGNOSTICS

• The physician may order a kidney, ureter, and
  bladder (KUB) radiograph. Renal ultrasonography
  or IVP will provide definitive information about
  structural changes.
• Other diagnostic tests may include visual
  examinations with the aid of endoscopy and a
  blood chemistry profile

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• An X ray of a blocked ureter. The ureters are
  muscular tubes that carry urine from the renal
  pelvis in each kidney to the urinary bladder.

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MEDICAL MANAGEMENT

• To establish urine drainage and relieve
  discomfort
• Conservative measures include insertion of an
  indwelling catheter, analgesic (usually opioid),
  and an anticholinergic agent (Atropine) to
  decrease smooth muscle motility
• To establish urine drainage, inserting a catheter
  directly into the bladder through the abdominal
  wall (suprapubic cystostomy)

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CONT

• Into a ureter (ureterostomy), or into the kidney
  (nephrostomy).
• A stent is a tube, use for surgical correction
  of an obstruction in the urinary system
• A mesh-like tube or coil-shaped device is
  inserted through an endoscope into the ureter
• Stent holds the tubular structure open to
  facilitate drainage.

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Nx INTERVENTIONS

• Observation for hemorrhage
• Maintaining aseptic care of surgical site
• Restoring optimal urinary function
• Providing a safe environment to prevent injury
  and infection

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PATIENT TEACHING

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• Liberal fluids to produce two litres of urine per
  day 
• Normalise serum uric acid level  
• Keep urine sterile 
• A diet without excessive sodium (salty food),
  calcium (dairy products), oxalate (nuts) and
  urates (for example, red meat) 
• Avoid excessive intake at dinner (overeating) and
  extend interval from dinner until retiring for
  the night 
• Urinary alkalinisation with addition of citrate
  (a stone inhibitor) is helpful in recurrent uric
  acid or calcium stone-formers

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PROGNOSIS

• Is variable, depending on the cause of the
  obstruction.
• If surgical correction is successful, the
  prognosis is excellent.

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