Obstruction of the urinary tract: diagnosis, prognosis
Structural or functional abnormalities in the organs responsible for the flow of urine, are a common cause of obstruction of the urinary tract. Obstruction is formed at any level from the kidney to the urethra, most often in areas of physiological narrowing. Based on the nature of the occurrence, obstruction of the ways that urine output may be congenital (malformation) or acquired (obstruction or compression).
Obstruction of the urinary systems: classification
Major congenital anomalies that cause obstruction is:
- contracture of the bladder neck;
- narrowing of the ureters or the urethra (stricture);
- pathological the anterior and the posterior valve of the urethra;
- the bulging wall of the urethra (diverticulum);
- narrowing of the meatus (matasanos);
- narrowing of the foreskin in men (phimosis);
- infringement of the glans ring of the foreskin (paraphimosis).
In the case of acquired disorders there are the following reasons:
- inflammation of the urethra, the uterus and its appendages;
- injuries in the pelvic region;
- the passage of necrotic papillae of the kidneys;
- tumors of the ureters, bladder, urethra or adjacent organs;
- obstruction to blood clots;
- cancer of the prostate, bladder, uterus, cervix, colon or colon;
- disruption of the nervous system (diabetic neuropathy);
- lesion of the spinal cord;
- seal of connective tissue retroperitoneum (fibrosis);
- the expansion of the aorta (aneurysm);
- uterine fibroids;
- prostate adenoma;
- inadvertent ligation during surgery.
Symptoms of obstruction are acute or chronic, depending on, affect one or both kidneys, unilateral or bilateral. There is both full and partial blockade of the urinary tract. So, for young people common cause of intestinal obstruction become kidney stones for the elderly — cancer or a tumor, for children — birth defects.
Symptoms depend on the form in which it manifests itself (acute or chronic), from the zone of lesion (unilateral or bilateral) and degree of obstruction (partial or complete). Chronic obstructive uropathy characterized by recurrent dull pain in side, frequent urination. If only one kidney, the amount of urine does not decrease. A significant decrease in urine output of said bilateral obstruction. Partial occlusion makes it difficult to urination, changed urine flow. When complete obstruction of the pain is worse, nausea and vomiting, increased body temperature.
The intensity of pain with obstruction caused by the rapid stretching of the bladder, ureter or kidneys, so while the acute form characterized by severe pain that spread to the testicles or vaginal area. The consequence of stretching of the kidney become renal colic, which lasts quite a long time, at short intervals.
Symptoms of the disease is very large, but one can distinguish the following common manifestations:
- pain in the side (one or both sides, aching or colicky);
- pus in the urine;
- the increase in body temperature;
- any discomfort or difficulty when urinating;
- nausea, vomiting;
- weight gain (edema);
- changes in urine output or lack of urine;
- blood in the urine.
Obstruction of the urinary tract with the complete cessation of the natural motion of the urine complicates the work of the kidneys and can cause acute renal failure. Rapid elimination of obstruction almost always helps to restore the normal working of the kidneys. At the same time, the late detection and elimination of obstruction significantly increase the risk of infection or stone formation, leading to atrophy and chronic renal failure. Obstruction of the urinary tract caused by the blockage leads to serious disturbances in the bladder, causing incontinence or retention of urine can become permanent.
The obstruction, as with any other disease, treatment efficacy and minimize negative effects depends on how quickly it was diagnosed. The diagnosis of urinary tract obstruction set, based on the results of these analyses are:
- Biochemical analysis of blood to determine the level of plasma electrolytes, urea nitrogen and creatinine.
- The analysis of urine.
- Katerinice bladder to determine the patency of the outlet of the bladder or urethra.
- Imaging methods which are selected based on the severity and location of the pathological process.
For more information, appoint a pelvic examination for women and prostate for men. Imaging examination help determine the exact location of the blockage and to confirm its presence, if there is a doubt. These include:
- Ultrasound. The method is quite accurate and safe, therefore shown to children and women during pregnancy.
- Alternative to ultrasound is the CT scan. CT is often used to identify stones and compression of the organs of the urinary system from the outside tumors.
If the ultrasound and CT scan do not give a clear result, then Refine using other visualization methods such as:
- cystourethroscopy (internal examination of the bladder);
- radionuclide scanning (assessment of renal function);
- excretory urography (definition of anatomical and functional state of the kidneys and urinary tract);
- retrograde and anterograde pyelography (obtain clear images of the upper urinary tract, pelvis and cups).
Forecast of obstruction
In most cases, with timely diagnosis eliminate the obstruction, but delayed treatment leads to irreversible kidney damage. But given the fact that for the normal operation of the organism is a single functioning kidneys, and irreversible renal failure is unlikely, except in cases of long-term (up to two weeks) obstruction of both kidneys. The cause of obstruction is also very important for the forecast. For example, the infection can be more serious than kidney stones.
Treatment of obstruction
The treatment is based on drug therapy, surgical removal or drainage of the urinary tract. If the urethra is clogged because of cancer or prostate enlargement, prescribed hormonal therapy. Also medication used in cases where obstruction is caused by functional disorders of the urinary system.
Immediate drainage is necessary if the obstruction is accompanied by infection, impaired renal function or persistent pain syndrome. In acute obstruction or stones can be assigned to continuous drainage using percutaneous nephrostomy, a tube that provides a discharge flow of urine. Surgery is used to eliminate tumors, polyps or scar tissue formed within and around the urethra and impede the normal flow of urine.