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Upper Tract
ObstructionWahjoe Djatisoesanto
Dept. of Urology
Airlangga University Dr.Soetomo Hospital
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ACUTE OBSTUCT!O"
ET!O#O$%
& Stone
& Slo'ghe( renal papillae
& Bloo( )lot
&A)'te retroperitoneal pathology& A))i(ental 'reteri) ligation
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ACUTE OBSTUCT!O"
*ATHO*H%S!O#O$%
& !ntrarenal press're
& enal +loo( ,o- B/0
& $lomer'lar 1ltration rate $/0
& T'+'lar f'n)tion
& O+str')tive atrophy
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S%2*TO2S 3 S!$"S
& Asymptomati) in)i(ental0
& Symptoms4
A)'te or )hroni) Uni or +i5lateral
!n or e65trinsi)
Complete or partial
/lan7 pain
"a'sea8 vomiting8 fever8 )hilling8 an'ria
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!"TA E"A# *ESSUE
Ti() C'**.%!%#.+r)%%&r) RBF
P,%) I 0 - 0 (in.
P,%)II 0 (in - ,
r)(in% )*)#)4 #' $)*'5 "'n#r'*4
P,%) III - 1 ,
#' r)%#in74 "'n#.)"r)%)4
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B!O2ECHA"!CS O/ UETE!COBSTUCT!O"
#a- of #apla)erelationship +et-een intral'minal press're8 vol'me 3 tension in the
-all of a )ompliant homogeneo's sphere 'n(er e9'ili+ri'm)on(itions
P.8.R9 T.;8.R
Si(+*i?i): P.R 9 T.2.R.).
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U**E TACT OBSTUCT!O"
!":EST!$AT!O"
;. !:*
. CT
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U**E TACT OBSTUCT!O"
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U**E TACT OBSTUCT!O"
!":EST!$AT!O"
;. !:*
. CT
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U**E TACT OBSTUCT!O"
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U**E TACT OBSTUCT!O"
!":EST!$AT!O"
;. !:*
. CT
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Fi7&r) : T,) )??)"# '? '$%#r&"#i'n 'n #,) r)n'7r( "&r). A (i* '$%#r&"#i'n
$ (')r#) '$%#r&"#i'n" ,i7,=7r) '$%#r&"#i'n.
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U"E?U!:OCA# CHO"!C OBSTUCT!O"
*athophysiology
& O+str')tion high i.r.press. fall " range0
& B/ (e)lines pre o+st.level after =5> h (e)lining tothe ne-8 re(')e( level
& $/ falls progressive
& T'+'lar f'n)tion a@e)te( hypotoni)
& Urinary osmolality 3 "a )ontent in)rease(
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U"E?U!:OCA# CHO"!C OBSTUCT!O"
*rimary mega 'reter
etro)aval 'reter
etroperitoneal 1+rosis
Urothelial t'mor
Ureteri) stone
Ureteri) stri)t're
Congenital
T'+er)'losis
Bilharial
!atrogeni)a(iation
etroilia) 'reter
Ovarian vein syn(romeEn(ometriosisE6trinsi) o+str')tion
Bo-el malignan)ies e.g. )olon0*elvi) malignan)ies e.g.)ervi60
*regnan)yUretero)eleBla((er )an)er2ala)opla7iaB*H*rostate Ca
*ro)i(entia*elvi) lipomatosisUrethral stri)t're*himosis
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E?U!:OCA# CHO"!C OBSTUCT!O"
U* stenosis
*rimary mega'reter
:U stenosis
Urinary (iversion
Apparent 'reteri) stri)t're
*regnan)y
!nfe)tive (ilatation
D'pli)ation
*revio's s'rgery4'reterolithotomyre5implantationpyelopasty
*revio's en(o'rology4'reteros)opy+as7etry
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U**E TACT OBSTUCT!O"
G In(i)ations of emergen)y (rainage
&Types of 'rinary (rainage
& Consi(erations in4
type of the pro)e('re
timing
& Case presentation
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U**E TACT OBSTUCT!O"
&Types of emergen)y (rainage
E6ternal4
"ephrostomy& Open
& *er)'taneo's *"S0
!nternal& Do'+le5 stenting
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U**E TACT OBSTUCT!O"
& Consi(erations in4
type of the pro)e('re
& Degree of (ilatation
& *atient )on(ition 555 positioning
& #o)al or generalregional anesthesia& Drainage only or (e1nitive treatment
timing
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U**E TACT OBSTUCT!O"
& !n(i)ations of emergen)y (rainage
O+str')tive an'ria
Urosepsis )a'se( +y
& *yonephrosis
& !nfe)te( Hy(ronephrosis
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CO"C#US!O"
& Upper Tra)t O+str')tion may +e a)'te or)hroni)8 'ni or +ilateral8 'ne9'ivo)al ore9'ivo)al
& Une9'ivo)al (iagnose( +y imaging te)hni9'e
& E9'ivo)al o+str')tion re9'ires f'n)tional an('ro(ynami) assessment
& Emergen)y (rainage is in(i)ate( -hen thereare o+str')tive an'ria an( pyonephrosis
& Hemo(ialysis is nee(e( if in(i)ate( an( sho'l(+e (is)'sse( appropriately
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