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Treatment for urinary tract obstructions

What Is Urinary Tract Obstruction?

Urinary obstruction may occur in any part of the urinary tract, but there are still certain points and organs which are more susceptible to obstructions than others. There are three critical points and those include the UVJ, the crossing of the ureter over the area of the pelvic brim at the level of the iliac vessels, and the UPJ. Urinary tract obstruction is a relatively common medical problem which may also be associated with certain medical complications such as urinary tract infections, painful sensations, loss in renal function, sepsis and sometimes even death. Those who suspect they have urinary tract obstructions should pay a visit to an urologist. There are certain types of urological emergencies which require immediate medical attention and treatment and those include nausea and vomiting sufficient to cause dehydration, uncontrolled pain, any suspicion of neurological dysfunction, renal failure, obstruction accompanied by infections or fever, any type of obstruction in a solitary kidney or complete urinary tract obstruction.

Diagnostic Procedures

There are a number of diagnostic procedures which need to be performed in patients who suspect they suffer from urinary obstructions. Among such procedures, the most common ones include several types of laboratory studies which include complete blood cell count, basic metabolic panel and urinalysis. The complete blood cell count may show anemia which indicates malignancy, chronic renal insufficiency or blood loss. Some cases may involve leukocytosis which is an excellent indicator of infections. Basic metabolic panel is an excellent way of diagnosing renal insufficiency by showing the levels of creatinine. Some cases of renal insufficiency may also be held responsible for the onset of acidosis or hyperkalemia. Urinalysis is an excellent way of evaluating the presence of hematuria or different sorts of infections. It may also show if there are any inflammatory conditions present in urinary tract. If it shows the presence of RBCs in the urine it may be an indication of tumors of stones in some cases. Other diagnostic procedures include cystoscopy and cystoscopy with retrograde pyelography. Cystoscopy involves passing a microscopic camera through the urethral meatus all the way into the bladder in order to check for any abnormalities in the bladder, bladder neck, prostatic urethra and the urethra. Retrograde pyelography sometimes accompanies the aforementioned process of cystoscopy and it involves the injection of radiographic dye into ureteral orifices. Further on, the process called fluoroscopy is then used for the visualization of any defects or abnormalities.

How Is this Condition Treated?

Generally speaking, all cases acute retention need to be treated by utilizing the process of urinary catheterization. If a person suffers from mild symptoms which do not affect the quality of life and do not involve any further complications, he or she simply needs to reduce the intake of fluids and avoid drinking alcoholic and caffeinated beverages. Alpha blockers and 5 alpha reductase inhibitors are often used as medicaments. All those who suffer from acute upper urinary tract obstruction need to be well aware of the fact that most stones that are smaller than 5 millimeters in diameter will pass on their own. It is usually in cases of stones that are bigger than 10 millimeters in diameter that an intervention is required. The symptoms of such acute cases of urinary obstruction in most cases do not last longer than 72 hours. A person usually suffers from painful sensations, inflammatory conditions and vomiting which can be managed quite easily by taking diclofenac or morphine. Those with renal colic should not worry much as long as they ingest sufficient amounts of fluids. Alpha blockers as a means of medical expulsive therapy may sometimes be used in order to increase the chance of passing a stone. Some cases of larger stones may also need to be taken care of by utilizing extracorporeal shock wave lithotripsy. If an urologist determines that the urinary obstruction is accompanied by an infection, drainage needs to be established as soon as possible, mostly by inserting a percutaneous needle right above the obstruction. This process is medicinally referred to as nephrostomy. In cases of pelvi urereric junction obstructions there are also a few treatment options which can be used. They include ureteroscopic endoureterotomy, endopyelotomy and pyeloplasty. Ureteroscopic endoureterotomy is used in cases accompanied by ureteric strictures, endopyelotomy involves an incision through the stenosis while the pyeloplasty requires an assistance from a robot. Malignant obstructions are commonly accompanied by underlying conditions which need to be treated with percutaneous nephrostomy or ureteric stenting so that the obstruction can be relieved.  In cases of idiopathic retroperitoneal fibrosis there needs to be a placement of stent or an ureterolysis needs to be performed so that the obstruction can be relieved.  In most cases certain types of immunosuppressive medicaments and corticosteroids are used as a part of the treatment method. Malignancy needs to be excluded by performing a biopsy of peri aortic mass. 

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