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The urinary tract is sort of like a very sophisticated plumbing system which is in charge of transporting the urine out of the body. The kidneys are in charge of filtering out all the waste products from the blood stream, while the urethra, bladder, ureters and the renal pelvis are the parts referred to as the urinary collecting system. Urinary tract obstruction is a term used for any type of blockage to the free flow of urine at any part of the urinary tract. These obstructions are known for being associated with increased pressure above the very point of obstruction and it may also lead to the pooling of the urine. Urinary tract obstructions are also commonly connected with a significantly increased risk of urinary tract injections and even kidney damage. The causes of such obstructions may occur at birth, and in that case they are referred to as the congenital ones. In other cases they are acquired, as they occur later on in life.

Children and Urinary Tract Obstruction

In most cases, urinary tract obstructions are discovered almost by accident, during some other studies or examinations of the body. These obstructions usually do not get manifested in children through any specific symptoms, but as the child gradually grows and develops, he or she starts experiencing a vast array of health problems. In most cases, such problems include renal failure, kidney damage, inability to urinate, palpable abdominal mass, urinary tract infections, abdominal pain and back pain. Long term outcomes in boys who suffer from urinary tract obstruction are largely unknown in most cases. 45 percent of the cases include acceptable renal functions, while every fifth boy who gets treated for urinary tract obstructions suffers from mild to moderate types of renal impairment. Every third boy who suffers from renal failure gets well after the procedure of renal transplant. Most treated cases also involved a significantly improved function of the bladder.

Types of Obstructions in Urinary System

There are numerous different types of obstructions which may occur in different parts of the urinary system. The upper urinary tract obstructions include UVJ obstruction, UPJ obstruction and ureterocele. UVJ obstruction commonly occurs in the narrow segment of the distal ureter at the place where it enters the urinary bladder. UPJ obstruction occurs in the narrow and short segment of the upper portion of the ureter where it junctions with the renal pelvis. Ureterocele is a medical term used for the abnormal dilation of the distal end of the ureter. The most common types of lower tract obstructions include the posterior urethral valves and meatal stenosis. Posterior urethral valves are actually valve leaflets which are responsible for blocking the urine flow out of the prostatic urethra. Meatal stenosis is a type of lower tract obstruction characterized by a stricture of the urethral meatus which is located at the tip of the penis. Lower urinary tract obstructions may be very dangerous because they may lead to severe kidney damage. The bladder muscle’s ability of contraction and appropriate coordination with sphincter muscles may sometimes be affected by the neurogenic dysfunction of the lower urinary tract.

Diagnostic Studies

There are certain types of diagnostic studies which may be of great help for all those who suffer from different types of urinary tract obstructions.  The most commonly used ones include renal ultrasound, diuretic renal scan, intravenous pyeigram, antegrade pressure pet-fusion study, urodynamics and voiding cystourethrogram. Renal ultrasound utilizes sound waves for the visualization of the kidneys while the diuretic renal scan is used for the examination of the kidneys’ drainage capabilities and overall functioning by injecting a radioisoiope contrast.  Intravenous pyeigram involves injection of iodine contrast and a number of x-ray scans. Antegrade pressure pet-fusion study involves a placement of a small tube into the kidneys which measures the renal pelvic pressure. Urodynamics is a process which involves passing gas or water into the bladder by means of a small catheter and it is very efficient in measuring the pressure inside the bladder. Voiding cystourethogram involves filling the bladder with iodine contrast fluids by means of a small catheters and then taking x-ray scans of it. Another diagnostic process which is commonly used in cases of lower urinary tract obstructions is called obstructive uropathy. It is actually an ultrasound with a very high resolution.

Management and Treatment Options for Urinary Tract Obstructions

In most cases, the specific site of obstruction is dealt with by utilizing corrective surgical procedures, so that the free flow of urine through the system may be re-established. The most common types of corrective surgical procedures for the urinary tract obstructions include meatotomy, TUR-valves, ureteral reimplantation and pyeloplasty. In some cases, the surgeries need to be accompanied by medications and intermittent catheterization.  The surgery is not always the first and the preferred option, so there need to be a satisfactory number of initial imaging studies. 

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