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Obstructive U ropathy

Obstructive U ropathy. Dr. Abdelaty Shawky Dr. G ehan Mohamed. * Causes of UT obstruction: 1. Urethral causes: phimosis – stricture - tumors. 2. Prostatic causes: BPH - cancer. 3. Bladder neck obstruction: functional, bilharziasis, stone, tumor.

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Obstructive U ropathy

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  1. Obstructive Uropathy Dr. Abdelaty Shawky Dr. Gehan Mohamed

  2. * Causes of UT obstruction: 1. Urethral causes: phimosis– stricture - tumors. 2. Prostatic causes: BPH - cancer. 3. Bladder neck obstruction: functional, bilharziasis, stone, tumor. 4. Ureteric causes: bilharzial stricture, stone, tumors, pregnancy, retroperitoneal fibrosis. 5. Renal pelvis causes: stone, tumor.

  3. Phimosis • Means narrowing of the external urethral orifice. a. Congenital: a condition where, in men, the foreskin cannot be fully retracted over the glans penis. b. Acquired: secondary to inflammatory lesions.

  4. Urinary calculi (stones) * Types: I. 1ry (metabolic) stones: • Calcium stones (calcium oxalate or phosphate). • Uric acid stone. • Cysteine stone. II. 2ry (Infected) stone: (Struvite stone). III. Compound stone.

  5. I. 1ry (metabolic) stones

  6. II. 2ry (infected) stone(struvite)

  7. III. Compound stone

  8. Stag horn stone : is the stone with branches formed within calyces and pelvis is termed stag horn-like or coral-like stone

  9. Calcium oxalate stones

  10. calcium oxalate crystals in urine

  11. Calcium phosphate stones

  12. Uric acid stone and its crystals in urine

  13. Cystine stones and its crystals in urine

  14. Diagnosis of renal calculi I. Clinical picture. II. Investigations.

  15. Asymptomatic if the stone do not cause any obstruction. Severe flank pain: colicky in nature (comes and goes in spasmodic waves). Pain in the back occurs when calculi produce an obstruction in the kidney or pain caused by peristaltic contractions of the ureter as it attempts to expel the stone Flank pain referred to genitalia Nausea, vomiting may mislead Microhematuria if stone have rough surface. I. Clinical Picture

  16. II. Investigations 1. Urine analysis: hematuria, infection, type of crystals. 2. X - Ray:most of renal stones are radiopaque due to calcification except uric acid stones are radiolucent so not seen. 3. Ultrasounography: can show stones and hydronephrosis. 4. Intravenous pyelogram (IVP): will show delayed function, hydronephrosis and hydroureter.

  17. X- Ray showing radio opaque stone

  18. Intravenous pyelogram (IVP) showing hydronephrosis and dilated calyx of the right kidney

  19. * Complications of renal stones: • Migration → pain & obstruction. • Obstruction → hydroureter& hydronephrosis or calculus anuria. • Hematuria due to Injury of urinary mucosa. • Infection → cystitis → pyelonephritis, pyoureter, pyonephrosis. • Metaplasia (squamous metaplasia) → squamous cell carcinoma..

  20. Hydronephrosis & Hydroureter

  21. Hydronephrosis

  22. Hydronephrosis

  23. Hydronephrosis

  24. Infected hydronephrosis (pyonephrosis)

  25. Thanks

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