Obstructive UropathyObstructive Uropathy

Dr. Abdelaty Shawky Dr. Gehan Mohamed Dr. Abdelaty Shawky Dr. Gehan Mohamed

* 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.

PhimosisPhimosis

• 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.

Urinary calculi (stones)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.

I. 1ry (metabolic) stonesI. 1ry (metabolic) stonesCa

oxalate/phosphate stone

Uric acid stone Cysteine stone

• Etiology hypercalcaemia Hyperuricemia cysteinuria

• Shape rounded rounded rounded

• Consistency hard firm soft

• Outer surface

spiny smooth smooth

• Color brown Light brown yellow

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

• Etiology Urinary tract infection which precipitate magnesium and ammonia

• Shape Rounded or stag horn

• Consistency Friable

• Outer surface Smooth

• Color white

III. Compound stoneIII. Compound stone

• Etiology 1ry stone followed by urinary tract infection

• Shape Rounded or stag horn stone

• Consistency Variable

• Outer surface Smooth

• Color variable

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

Calcium oxalate Calcium oxalate stones stones

calcium oxalate calcium oxalate crystals in urinecrystals in urine

Calcium phosphate stonesCalcium phosphate stones

Uric acid stone and its crystals in urineUric acid stone and its crystals in urine

Cystine stones and its crystals in urineCystine stones and its crystals in urine

Diagnosis of renal calculiDiagnosis of renal calculi

I. Clinical picture.I. Clinical picture.

II. Investigations.II. Investigations.

I. Clinical PictureI. Clinical Picture• 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.

II. InvestigationsII. Investigations1. Urine analysis1. Urine analysis: : hematuria, infection, type of crystals.

2. X - Ray:2. X - Ray: most of renal stones are radiopaque due to

calcification except uric acid stones are radiolucent so not

seen.

3. Ultrasounography: 3. Ultrasounography: can show stones and hydronephrosis.

4. Intravenous pyelogram (IVP): 4. Intravenous pyelogram (IVP): will show delayed function,

hydronephrosis and hydroureter.

X- Ray showing X- Ray showing radio opaque stoneradio opaque stone

Intravenous pyelogram Intravenous pyelogram

(IVP) showing (IVP) showing

hydronephrosis and hydronephrosis and

dilated calyx of the right dilated calyx of the right

kidneykidney

* 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..

Hydronephrosis & Hydroureter

Hydronephrosis

HydronephrosisHydronephrosis

Hydronephrosis

Infected hydronephrosis (pyonephrosis)Infected hydronephrosis (pyonephrosis)

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