management of upper urinary obstruction
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management of upper urinary obstruction
- 1. Management of Upper Urinary Tract Obstruction By: Ismah Haron
- 2. Relief the obstruction: • Ureteral stent - Procedure is along with cystoscopy and fluroscopy/x ray - Side effects; nil or frequency, dysuria, hematuria - Take note if feverish, severe hematuria, loin pain • Nephrostomy tube
- 6. Reduce the symptoms: Treat underlying cause: • Analgesic • Antipyretic • Antibiotic
- 7. Stones • Pass spontaneously • Extra-corporeal shockwave lithotripsy • Percutaneous nephrolithotomy • Endoscopic treatment - ureteroscope • Open nephrolithotomy/ureterolithotomy • Prevention from recurrence
- 11. • Prevention from recurrence; - Increase fluid intake - Reduce Ca intake - Correct metabolic abnormalities - Treat infection - Urinary alkalization
- 12. THANK YOU
Notes de l'éditeur
- http://emedicine.medscape.com
- Ureteral stent
- Figure 1. Some currently available ureteral stents. Stent A is a 6-F polyurethane stent with standard proximal and distal pigtail loops to prevent migration and fenestrations along the entire shaft length. Stent B is a 7-F silicone stent with holes in the loops only. (Stents A and B are manufactured by and shown courtesy of Cook Urological, Spencer, Ind.) Stent C is a Flexima ureteral stent (Boston Scientific). This 10-F stent has a hydrophilic coating and holes in the loops only. Stent D is an Ultrathane Amplatz ureteral stent (Cook, Bloomington, Ind). This 8.5-F polyurethane-latex stent has a hydrophilic coating and metal markers indicating shaft length (arrowheads). Stent E is a C-Flex Towers multilength stent (Cook Urological). This 6-F stent has a hydrophilic coating and ridges rather than fenestrations along its length to assist with urine flow. The internal lumen accommodates a .028-inch guide wire. Note the multiple coils on each end of the stent (arrows), which give a usable shaft length of 22-32 cm.
- Illustration of a nephrostomy tube and drainage bag
- Antibiotics are often given for prophylaxis and should cover common urinary tract pathogens. Commonly used antibiotics include trimethoprim-sulfamethoxazole, nitrofurantoin, cephalosporins, and fluoroquinolones. Pain secondary to urinary tract obstruction is often managed with oxycodone, hydrocodone, acetaminophen, and nonsteroidal anti-inflammatory medications
- ESWL
- Percutaneous nephrolithotomy
- Uteroscope