Obstructive urinary tract disease
Introduction
Introduction to obstructive urinary tract disease Obstructive urinary tract disease is common at any age. 4% of patients found hydronephrosis (a result of kidney disease) at autopsy, the same gender distribution, obstructive urinary tract disease is more common in men >60 years of age, because of benign prostatic hyperplasia and prostate cancer The incidence has increased. In the United States, 2 out of every 1,000 people are hospitalized for obstructive urinary tract disease. basic knowledge Sickness ratio: 0.0004% Susceptible population: common in men over 60 years old Mode of infection: non-infectious Complications: hydronephrosis
Cause
Causes of obstructive uropathy
Obstructive urinary tract diseases can be classified as acute or chronic, partial or complete, and unilateral or bilateral. It can occur at any level from the renal tubule (tubular, crystallization) to the external urethra, resulting in increased intraluminal pressure, urinary tract, urinary tract infections and stone formation.
Male urethral obstruction can be caused by benign prostatic hyperplasia, prostate cancer, chronic prostatitis with fibrosis, foreign body, bladder neck contraction or congenital urethral valve. The urethral and urethral strictures can be acquired or congenital. Female rare urethral obstruction, but can occur secondary to tumors, radiotherapy, surgery or the use of urinary tract instruments (usually repeated expansion).
Obstructive nephropathy (kidney dysfunction, renal failure, or tubulointerstitial damage) may be due to increased intraluminal pressure, ischemia, or often associated with urinary tract infections. Inflammatory T cells and macrophage infiltration, autoimmune responses to reflux urine Tamm-Horsfall mucin, and vasoactive hormones may also be involved in damage to the kidneys.
Pathology is characterized by dilatation of the collecting duct and distal tubules and atrophy of the chronic tubules, while glomerular damage is minor. Obstructive urinary tract disease without urinary dilatation may occur in the posterior peritoneal tumor or fibrous wrapping system; the lesion is mild, the renal function is not damaged, and the urinary tract obstruction occurs within 3 days; the systolic system compliance is relatively poor and difficult to expand. Obstructive urinary tract disease can occur in 2% of children, often with congenital urinary tract abnormalities.
Prevention
Obstructive urinary tract disease prevention
Usually pay attention to protein, cereals, vegetable cellulose in the diet.
Complication
Obstructive urinary tract disease complications Complications hydronephrosis
Intravesical urinary retention, ureteral hydrops, hydronephrosis, and renal papillary necrosis are common complications.
Symptom
Obstructive urinary tract disease symptoms Common symptoms oliguria low back pain low back pain with kidney area sputum pain
Obstructive urinary tract disease should be considered in all patients with unexplained renal insufficiency. A history may suggest symptoms of benign prostatic hyperplasia or precancerous lesions or urolithiasis.
If there is a bladder neck obstruction (such as suprapubic pain, bladder can be paralyzed or unexplained renal failure in elderly men), bladder intubation should be performed first. If urethral obstruction (such as stenosis, valve) is suspected, further identification is required. Probable causes and severity of prostate and bladder lesions should be performed with urethroscopic and urethroscopic angiography.
Abdominal ultrasound is the preferred procedure for most patients, as avoiding radiation contrast agents may cause complications of allergies and poisoning. However, if only minor criteria (collective system development) are considered in the diagnosis, the false positive rate can reach 25%. Ultrasound examination, abdominal X-ray film, if necessary CT can diagnose >90% of patients with obstructive uropathy.
By detecting an increase in the resistance index of the affected side of the kidney (reflecting an increase in renal vascular resistance), Doppler ultrasonography usually diagnoses unilateral urinary tract obstruction.
Before intravenous urography, radionuclide kidney scan or retrograde angiography, patients should be given appropriate diuretics (such as furosemide 0.5mg / kg intravenously) for diuresis to check the extent of hydronephrosis and emptying time Relatively extended.
Intravenous urography can identify the location of urinary tract obstruction, can detect the accompanying lesions (such as pyelosis caused by previous infection, nipple necrosis), false positive rate is very low. However, intravenous urography is troublesome and requires radiography Intravenous urography is mainly used for the presence of staghorn calculi or multiple renal cysts or pararenal cysts (ultrasound and CT usually cannot identify cysts or stones from hydronephrosis); when CT can not clearly determine the level of obstruction; Acute urinary tract obstruction is caused by stones, nipples or blood clots when screening for urinary tract obstruction. Acute obstructive urinary tract disease may not expand the collection system, but if there is mechanical obstruction factors (such as stones) can be located.
An antegrade or retrograde pyelography is usually used to relieve urinary tract obstruction, not for diagnosis. However, when the medical history strongly suggests functional or anatomical abnormalities, even if there is no hydronephrosis, the delay in emptying time can be confirmed. Single dehydration can extend the emptying time. When the renal pelvis examination shows that a kidney is not functional, radionuclide scanning can identify renal perfusion and clear functional renal parenchyma.
Examine
Examination of obstructive urinary tract disease
1. Urine examination: When there is a concomitant infection, there may be white blood cells and pus cells in the urine. The medium urine culture has non-specific bacteria growth, and there are red blood cells in the urine when stones are formed.
2. Cystoscopy: When the lower urinary tract obstruction, cystoscopy can be found in prostate hyperplasia, bladder neck contracture, bladder stones and intravesical trabeculae, small chamber, diverticulum and other diseases.
3. Urinary angiography: When the stones are complicated, the opaque stones can be displayed on the plain film. When the upper urinary tract is obstructed, the affected side often has hydronephrosis. The severe hydronephrosis often causes loss of renal function without development, ureteral hydrops. Can show enlargement, distortion, etc., when the lower urinary tract obstruction, the bladder corridor is irregular, the size and location of the diverticulum can be displayed when there is a diverticulum, and the urethral urethra can show urethral stricture and valvular lesions.
4. B-mode ultrasound examination: When the upper urinary tract obstruction, the affected side kidney can often find the liquid level segment, suggesting that there is hydronephrosis, and when the stone is stones, the stone and its shadow can be detected. When the lower urinary tract is obstructed, the bladder is inside. Different degrees of residual urine can be measured.
5. CT scan examination: When the upper urinary tract obstruction, in addition to the detection of hydronephrosis, the CT scan can still determine the thickness of the renal cortex, which has important reference value for determining the treatment plan. CT scan can still detect the stone shadow. Pediatric and ureteral tumors can sometimes be found.
6. Renal function test: early obstruction, renal function often does not change, unilateral upper urinary tract obstruction often causes renal dysfunction of the affected side, can be confirmed by rouge test, isotope kidney diagram and intravenous urography, long-term upper urinary tract Obstruction and lower urinary tract hard resistance can cause renal insufficiency on both sides, blood urea nitrogen and creatinine increase, isotope kidney map can show impaired renal function or obstructive kidney map,
7. Urodynamic examination: When the lower urinary tract obstruction, the maximum urinary flow rate decreased (<10ml/sec=, the intravesical pressure during urination was significantly increased (>70cm water column).
Diagnosis
Diagnosis and diagnosis of obstructive urinary tract disease
diagnosis
According to the medical history, clinical manifestations and laboratory data is not difficult to make a diagnosis.
Differential diagnosis
It is differentiated from prostatic hypertrophy, tumor, or neurogenic urinary retention.
