Materiały źródłowe

• #1 Urinary Tract Obstruction: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/438890-overview

  Obstructive uropathy has an annual incidence of 1.7 per 1000 population. It causes approximately 10% of all cases of acute kidney injury and chronic kidney disease. […] In an autopsy series of 59,064 patients aged 0-80 years, the frequency of hydronephrosis was 3.1%. In women with uterine prolapse, hydronephrosis occurs in approximately 5% with first-degree prolapse and in 40% with third-degree prolapse. […] Hydronephrosis is found in 2-2.5% of children. Prenatal hydronephrosis is the most common urinary tract anomaly, occurring in 1-5% of pregnancies. Approximately 25% of these cases are caused by urinary obstruction. […] In women, hydronephrosis is more likely develop during the third to seventh decade of life, secondary to pregnancy and gynecologic malignancies. In men, hydronephrosis occurs most often after age 60 years, secondary to prostatic obstruction.

• #2 Ureteral obstruction – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ureteral-obstruction/symptoms-causes/syc-20354676

  A ureteral obstruction is a blockage in one or both of the tubes (ureters) that carry urine from the kidneys to the bladder. Ureteral obstruction can be cured. However, if it’s not treated, symptoms can quickly move from mild pain, fever and infection to severe loss of kidney function, sepsis and death. […] Ureteral obstruction is fairly common. Because it’s treatable, severe complications are rare. […] Ureteral obstruction can lead to urinary tract infections and kidney damage, which can be irreversible.

• #3 Urinary Tract Obstruction | Radiology Key

  https://radiologykey.com/urinary-tract-obstruction/

  UTO is a common clinical and uroradiologic diagnostic problem. The incidence of hydronephrosis in one autopsy series was 3.1%, with no difference in incidence between the sexes in patients younger than age 20 years. It is more common in women than men between 20 and 60 years of age (owing to obstetric and gynecologic causes) and more common in men older than 60 years (predominantly owing to benign prostatic hyperplasia). Hydronephrosis is the most common cause of an abdominal mass in neonates, and UTO is the most common cause of end-stage renal failure in children. […] UTO has been defined as a narrowing such that proximal pressure must be raised to transmit usual flow. It is important to understand that this definition does not refer to dilation of the urinary tract. UTO may occur without dilation and dilation may occur without UTO, creating potential causes of false-negative and false-positive findings in radiologic investigations of UTO.

• #4 Ureteral obstruction | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/ureteral-obstruction

  Ureteral obstruction is fairly common. Because it’s treatable, severe complications are rare. […] Ureteral obstruction can lead to urinary tract infections and kidney damage, which can be irreversible. […] Often, providers diagnose ureteral obstruction disorders before birth during routine prenatal ultrasounds, which can show details of the developing fetus, including the kidneys, ureters and bladder. Providers often perform another ultrasound after birth to reevaluate the kidneys. […] The goal of ureteral obstruction treatment is to remove blockages, if possible, or bypass the blockage, which may help repair damage to the kidneys. Treatment might include antibiotics to clear associated infections.

• #5 Urinary Tract Obstruction (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/urinary-tract-obstruction

  Urinary tract obstruction occurs most commonly in the young and the old: […] In older men, this is a relatively common condition due to prostatic enlargement: […] Incidence of lower urinary tract symptoms (LUTS)/BPH averages 15 per 1,000 man-years. […] In the age range 45-49, it is 3 per 1,000 man-years but increases to 38 per 1,000 man-years by age 75-79. […] Acute urinary retention (AUR) is a relatively uncommon sequela, with a cumulative incidence of 2% over almost five years in men with symptomatic BPH. […] Hydronephrosis due to a congenital abnormality is relatively common: […] Prenatally, 1 in 100 fetuses are found to have hydronephrosis on ultrasound – most resolve. […] An analysis of children presenting incidentally after renal tract trauma found an incidence of congenital renal tract abnormalities of 8.3% – most commonly, PUJ obstruction.

• #6 Urinary Tract Obstruction (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/urinary-tract-obstruction

  In men, urinary tract obstruction is most commonly a consequence of BPH or urethral stricture. […] In women, it tends to be related to pelvic tumours (particularly gynaecological malignancies), prolapse of pelvic structures, or pregnancy. […] Congenital urethral tract obstructions are more common in boys/male fetuses, particularly posterior urethral valves.

• #7 Ureteral Obstruction: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21155-ureteral-obstruction

  Ureteral obstructions are fairly common. Theyre more common in men over 60 because their prostates enlarge as they age. […] Ureteral obstruction prevents pee from moving into your bladder and out of your body. Without treating and removing the blockage, pee can back up and damage your kidneys. […] If left untreated, obstruction of your ureter can cause serious problems. […] The outlook for ureteral obstruction depends on whether your kidneys were damaged while pee was unable to drain. If your healthcare provider fixes the blockage before serious kidney damage occurs, ureteral obstruction doesnt usually have serious long-term effects.

• #8 Ureteric calculi | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ureteric-calculi?lang=us

  The lifetime prevalence of ureteric calculi is relatively high, occurring in approximately 12% of men and 7% of women. The risk is increased with a past history of ureteric calculi and with positive family history. Most patients present between ages 30 and 60 years, with peak incidence between ages 35-45 years. Initial calculus presentation occurring past age 50 years is uncommon. […] In addition to history of prior ureteric calculi and family history, other risk factors for ureteric calculi include low fluid intake, frequent urinary tract infections and medications that may crystallize within the urine.

• #9 Ureteropelvic Junction Obstruction: Background, History of the Procedure, Problem

  https://emedicine.medscape.com/article/450785-overview

  Epidemiologic features of UPJ obstruction are as follows: […] UPJ obstruction is found in approximately 50% of patients diagnosed with antenatal hydronephrosis […] The male-to-female ratio of UPJ obstruction is 3-4:1 […] In general, the left kidney is more commonly affected than the right kidney […] UPJ obstruction is less common in adults than in children but is not rare in either population […] UPJ obstruction is bilateral in 10% of cases.

• #10 Congenital ureteropelvic junction obstruction – UpToDate

  https://www.uptodate.com/contents/congenital-ureteropelvic-junction-obstruction

  Ureteropelvic junction (UPJ) obstruction is a partial or intermittent blockage of the flow of urine that occurs where the ureter enters the kidney. The etiology of UPJ obstruction includes both congenital and acquired conditions. UPJ obstruction is the most common pathologic cause of antenatally detected hydronephrosis. […] The reported incidence of UPJ obstruction is 1 in 500 live births screened by routine antenatal ultrasound; however, not all cases require surgical intervention. The goal is to identify which patients with UPJ-type hydronephrosis have obstruction. UPJ obstruction is the most common anatomical cause of antenatal hydronephrosis. […] UPJ obstruction is more common among boys than girls and on the left rather than right side. The reported rate of bilateral involvement is approximately 10 percent.

• #11 Ureteropelvic Junction or UPJ-Obstruction: Diagnosis and Treatment

  https://www.urology-textbook.com/upj-obstruction.html

  A ureteropelvic obstruction causes up to 48% of fetal hydronephrosis. […] The Incidence of UPJ obstruction is 1:1500. 60% on the left side and 10-40% of cases involve both kidneys. Male to female ratio is 2:1 in the neonatal age group. […] In 10% of patients with severe vesicoureteral reflux, UPJ obstruction exists (or develops).

• #12 Ureteropelvic Junction Obstruction | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/ureteropelvic-junction-obstruction

  UPJ obstructions are not very common, occurring in approximately 1 out of every 1,500 babies. […] If a UPJ obstruction is detected early, it can be treated fairly easily. […] If left untreated or misdiagnosed, however, the chronic backup of urine into the kidney can do permanent damage to your child’s kidneys and urinary system. […] The exact cause of UPJ obstructions is not known, but they are congenital (present at birth) and are often discovered during a routine prenatal ultrasound, which suggests that they arise from problems in the development of your child’s urinary tract. […] In general, your child’s treatment depends on the severity of the blockage. […] If the obstruction is larger, your doctor may choose to closely monitor your child with repeated ultrasound tests. […] In the most severe cases, where your child’s kidney is at risk of damage from chronic backup of urine, surgery may be necessary. […] If left untreated, however, the chronic backup of urine into the kidney can damage your child’s kidneys.

• #13 Ureteropelvic Junction (UPJ) Obstruction | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/ureteropelvic-junction-upj-obstruction

  Unilateral UPJ obstruction is the most common prenatally detected obstructive disease, often picked up on maternal ultrasounds during pregnancy. Each year, the Division of Urology treats nearly 150 children who have a UPJ obstruction. […] Due to the increased use of prenatal imaging, UPJ obstruction may be identified before any symptoms are present. […] Our overall goal in the Division of Urology in treating a UPJ obstruction is to preserve renal function.

• #14 The incidence of ureteral obstruction and the value of intraoperative cystoscopy during vaginal surgery for pelvic organ prolapse – PubMed

  https://pubmed.ncbi.nlm.nih.gov/16647931/

  The objective of the study was to determine the incidence of ureteral obstruction during vaginal surgery for pelvic organ prolapse and the accuracy and efficacy of intraoperative cystoscopy. […] Thirty-seven patients (5.3%) had no spillage of dye from 1 or both ureters intraoperatively. The false-positive and negative cystoscopy rates were 0.4% and 0.3%, respectively. Thus, the true incidence of intraoperative ureteral obstruction was 5.1%. […] Vaginal surgery for anterior and/or apical pelvic organ prolapse is associated with an intraoperative ureteral obstruction rate of 5.1%. Intraoperative cystoscopy accurately detects ureteral obstruction and allows for relief of obstruction in the majority of cases.

• #15

  https://journals.lww.com/cur/fulltext/2024/03000/the_challenging_management_of_malignant_ureteral.8.aspx

  Malignant ureteral obstruction (MUO) is a common condition that complicates the course of advanced malignancies. The aims of this study are to analyze the causes, management, and survival of patients with obstructive nephropathy due to malignant ureteric obstruction and to determine prognostic factors. […] A total of 188 patients were included. The mean age was 69.01 years (SD, 14.95 years), and the majority (54.8%) were male. The most common mechanism leading to MUO was compression by a pelvic mass (36.9%), and the 3 most frequent tumors causing MUO were prostate (17.6%), bladder (16.5%), and rectal cancer (11.7%). […] Forty-seven patients (25%) underwent urinary diversion: 23 (48.9%) underwent double-J stenting and 21 (44.7%) underwent percutaneous nephrostomy. The most common reason for urinary diversion was acute kidney injury (53.3%). Recovery of renal function was observed in 55.8% of the patients after urinary diversion.

• #16 Update on the Management of Malignant Ureteral Obstruction – American Urological Association

  https://auanews.net/issues/articles/2023/may-2023/update-on-the-management-of-malignant-ureteral-obstruction

  Malignant ureteral obstruction (MUO) is a common condition for urologists to manage. MUO may result from obstruction of a primary urothelial tumor, direct invasion from a nonurological malignancy, or compression from a tumor or metastatic lesion. Patients may present with renal colic, mild and nonspecific symptoms, or may be asymptomatic. With the latter, the obstruction is identified through abnormal laboratory findings or hydronephrosis incidentally found on imaging. In addition to pain, MUO may compromise renal function and lead to renal failure. […] MUO is associated with unfavorable oncologic prognosis with patients typically having a life expectancy of less than 1 year. Individualized prognosis and end of life or quality of life goals must be considered when deciding whether to intervene with ureteral decompression given that treatment-related side effects can lead to significant decreases in quality of life.

• #17

  https://journals.lww.com/cur/fulltext/2024/03000/the_challenging_management_of_malignant_ureteral.8.aspx

  Cancer patients with MUO have a poor prognosis; therefore, the risk-benefit ratio of urinary diversion should be carefully considered. Cachexia and hydronephrosis grade can be useful in selecting suitable candidates for urinary diversion. […] Ureteral obstruction is commonly seen as the final stage of many malignancies and is often associated with disease progression and the terminal phase. Furthermore, it implies poor survival, with several studies reporting a median survival of less than 1 year. […] Although MUO is frequent in everyday clinical practice and is a challenging issue as well as an ethical dilemma, there are few studies on troubleshooting difficulties associated with its management. […] The median overall survival (OS) from hydronephrosis diagnosis was 6.43 months (IQR, 1.9114.81 months) in our series of 188 cancer patients.

• #18

  https://journals.lww.com/cur/fulltext/2024/03000/the_challenging_management_of_malignant_ureteral.8.aspx

  The median survival after urinary diversion was 8.67 months (IQR, 2.9917.28 months) for the 48 of 188 patients who underwent this procedure. […] Univariate Cox regression analysis revealed that cancer cachexia, grade of hydronephrosis, chemotherapy line, and type of primary malignancy were associated with survival time from MUO diagnosis. […] Multivariate Cox regression analysis revealed that the response to therapy on CT was an independent prognostic factor in urological cancers. […] The palliative nature of urinary diversion in the context of MUO makes the assessment of QoL a key element in determining the success of urinary diversion.

• #19 Feline Urethral Obstruction: Diagnosis & Management

  https://todaysveterinarypractice.com/urology-renal-medicine/feline-urethral-obstruction-diagnosis-management/

  Feline urethral obstruction (UO) is a common disorder encountered in small animal emergency practice, with incidence estimates ranging from 1.5% to 9%. […] The etiology of UO was long thought to be a physical obstruction, such as a urethral plug, calculi, stricture, or neoplasia. In a recent study, however, causes of UO in 45 cats were found to be idiopathic (53%), uroliths (29%), and urethral plugs (18%), indicating that functional obstructions may be more common than previously thought. […] Treatment commonly involves days of hospitalization, with substantial owner investment, and rates of recurrence following treatment are relatively high (range, 11%–43%). […] Given their relatively long and narrow urethra, male cats are much more likely than female cats to develop obstruction. […] In addition, obstructed cats were more likely to live indoors only, weigh more, and be fed a dry diet exclusively.

• #20 Acute ureteral obstruction (Proceedings)

  https://www.dvm360.com/view/acute-ureteral-obstruction-proceedings-0

  Ureteral obstruction is now a common challenge for practitioners, internists and surgeons in veterinary medicine. […] Ureteral obstruction is a common cause of acute azotemia as well as chronic progressive renal disease in dogs and cats. […] Recognition of upper urinary tract obstruction requires imaging studies such as radiographs and ultrasonographic examination. […] Many ureteroliths will spontaneously pass into the lower urinary tract with time and/or diuresis. […] Persistently obstructive ureteroliths require surgical or lithotripsy intervention. […] Prognosis for recovery of urinary function depends on the degree and duration of obstruction. […] Prognosis for ureteroliths in dogs is generally good. […] Prognosis for ureteroliths in cats is good if the urolith passes, or if surgical or lithotripsy removal is successful prior to significant loss of renal function. […] Short term morbidity and mortality in cats with severe uremia is high unless dialytic support is available (hyperkalemia, acidosis, death). […] Short term morbidity in cats following ureteral surgery is high (urine leakage, renal deterioration, dehiscence, stricture).

• #21 Ureteral obstruction | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/ureteral-obstruction?content_id=CON-20208697

  Often, providers diagnose ureteral obstruction disorders before birth during routine prenatal ultrasounds, which can show details of the developing fetus, including the kidneys, ureters and bladder. Providers often perform another ultrasound after birth to reevaluate the kidneys. […] The goal of ureteral obstruction treatment is to remove blockages, if possible, or bypass the blockage, which may help repair damage to the kidneys. Treatment might include antibiotics to clear associated infections.

• #21 Ureteral obstruction | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/ureteral-obstruction?content_id=CON-20208697

  A ureteral obstruction is a blockage in one or both of the tubes (ureters) that carry urine from the kidneys to the bladder. Ureteral obstruction can be cured. However, if it’s not treated, symptoms can quickly move from mild pain, fever and infection to severe loss of kidney function, sepsis and death. […] Ureteral obstruction is fairly common. Because it’s treatable, severe complications are rare. […] Certain conditions present at birth can increase the risk of having ureteral obstruction. Having kidney stones or bladder stones also might increase the risk that one of the ureters becomes blocked. Blood clots, tumors, certain tissue growth and enlarged lymph nodes might also be factors in developing this condition. […] Ureteral obstruction can lead to urinary tract infections and kidney damage, which can be irreversible.

• #22 Intermediate term outcomes associated with the surveillance of ureteropelvic junction obstruction in adults – PubMed

  https://pubmed.ncbi.nlm.nih.gov/21251676/

  Purpose: We determined the outcome of minimally symptomatic adult ureteropelvic junction obstruction in a group of patients treated conservatively with an active surveillance regimen. […] Active surveillance seems to be a reasonable initial option for asymptomatic or mildly symptomatic adult patients with ureteropelvic junction obstruction because only approximately 30% have progression to surgical intervention within 4 years of diagnosis. This strategy offers the advantage of individualizing therapy according to symptoms and renographic findings.

• #23 Ureteropelvic junction obstruction | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ureteropelvic-junction-obstruction?lang=us

  Ureteropelvic junction obstruction on antenatal ultrasound affects about 1:500 fetuses. It is more common in males and is usually unilateral (90%) being more frequent on the left. […] In a majority of congenital cases, the condition is benign, and usually, no intervention is required. However, when there is a definitive structural obstruction (commonly adult cases), surgical intervention with pyeloplasty or stenting may be necessary.

• #24 Feline Urethral Obstruction: Diagnosis & Management

  https://todaysveterinarypractice.com/urology-renal-medicine/feline-urethral-obstruction-diagnosis-management/

  Postobstructive diuresis (POD) is a well-described phenomenon in human medicine that may result secondary to UO in cats as well. In one study, 46% (13/28) of cats developed POD, defined as urine production exceeding 2 mL/kg/H within 6 hours after relief of UO. […] The high incidence of POD calls for close measurement of urine output and continued IV fluid administration using an “ins and outs” fluid therapy protocol after resolution of hypovolemia.

• #25 Masquerading as A Stone: An Unusual Cause of Chronic Ureteric Obstruction – Journal of Urological Surgery

  https://jurolsurgery.org/articles/masquerading-as-a-stone-an-unusual-cause-of-chronic-ureteric-obstruction/doi/jus.galenos.2021.2021.0040

  Amyloidosis is a group of disorders characterized by the extracellular deposition of amorphous, misfolded proteins. […] Presented herein is a case of a 76-year-old female who presented with sepsis, distal ureteric calculus, and chronic ureteric obstruction without the classical symptoms of bladder amyloidosis. […] The patient did not present with the classical symptoms of lower urinary tract symptoms or macroscopic hematuria. […] Our patient presented with sepsis due to obstructive uropathy. […] The PLBA possibly obstructed the left ureteric orifice gradually with subsequent development of hydronephrosis, renal cortical atrophy, and infection. […] Given that recurrence rates are as high as 50%, annual cystoscopic surveillance is recommended. […] In conclusion, this is a very unusual case of PLBA, presenting with infection and chronic ureteric obstruction without lower urinary tract symptoms or macroscopic hematuria.

• #26 Ureteral obstruction | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20208697/

  Ureteral obstruction is fairly common. Because its treatable, severe complications are rare. […] Ureteral obstruction can lead to urinary tract infections and kidney damage, which can be irreversible. […] Different types of ureteral obstruction have different causes, some of them present at birth (congenital). […] Certain conditions present at birth can increase the risk of having ureteral obstruction. Having kidney stones or bladder stones also might increase the risk that one of the ureters becomes blocked. […] Often, providers diagnose ureteral obstruction disorders before birth during routine prenatal ultrasounds, which can show details of the developing fetus, including the kidneys, ureters and bladder. […] The goal of ureteral obstruction treatment is to remove blockages, if possible, or bypass the blockage, which may help repair damage to the kidneys.

• #27

  https://journals.lww.com/ijmh/fulltext/2024/29040/prevalence_and_pattern_of_urinary_tract.8.aspx

  Urolithiasis is a global problem and its prevalence is steadily increasing. This trend is also true in tropical and sub-Saharan Africa. Urinary tract obstruction is a common complication of untreated urolithiasis. […] Epidemiological data on the prevalence and pattern of urinary tract obstruction from urolithiasis is limited in the literature. This study tends to fill this gap in knowledge and, in addition, it highlights the importance of early relevant imaging investigations in individuals with symptoms suggestive of urolithiasis. […] The prevalence of stone-induced urinary tract obstruction in this study was 46.3%. […] Renal obstruction from stones remains a common and reversible cause of renal failure. This study reviews the prevalence and pattern of urinary tract obstruction from calculi and highlights the importance of doing relevant imaging investigations early in individuals with symptoms suggestive of urolithiasis.

• #28 Diagnosis and Initial Management of Kidney Stones | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0401/p1329.html

  The prevalence of urolithiasis is approximately 2 to 3 percent in the general population, and the estimated lifetime risk of developing a kidney stone is about 12 percent for white males.1 Approximately 50 percent of patients with previous urinary calculi have a recurrence within 10 years.2 […] Stone disease is two to three times more common in males than in females. It occurs more often in adults than in elderly persons, and more often in elderly persons than in children. Whites are affected more often than persons of Asian ethnicity, who are affected more often than blacks. In addition, urolithiasis occurs more frequently in hot, arid areas than in temperate regions. […] Decreased fluid intake and consequent urine concentration are among the most important factors influencing stone formation. Certain medications, such as triamterene (Dyrenium), indinavir (Crixivan) and acetazolamide (Diamox), are also associated with urolithiasis. Dietary oxalate is another possible cause, but the role of dietary calcium is less clear, and calcium restriction is no longer universally recommended.3

• #29 EAU Guidelines on Urethral Strictures – Uroweb

  https://uroweb.org/guidelines/urethral-strictures/chapter/definition-epidemiology-aetiology-and-prevention

  In males, a sharp increase in incidence is observed after the age of 55 years, with a mean age of 45.1. […] Overall, the incidence is estimated to be 229-627 per 100,000 males. The anterior urethra is most frequently affected (92.2%), in particular the bulbar urethra (46.9%). […] In females, 2-29% of patients presenting with refractory lower urinary tract symptoms (LUTS) have bladder outflow obstruction (BOO) of whom 4-20% will have a urethral stricture. True FUS therefore occurs in 0.08-5.4% of women with refractory LUTS. There is a markedly increased incidence in women over 64 years of age. […] After hypospadias repair, meatal stenosis and urethral strictures are reported in 1.3-20% of cases, depending on the severity of the hypospadias and the technique used. […] In female-to-male (FtM) transgender patients (transmen), 2-56% will suffer a urethral stricture. Strictures almost exclusively arise at the neomeatus in male-to-female (MtF) transgender patients (transwomen) and occur in 4-40% of cases.

• #30

  https://revistas.unilibre.edu.co/index.php/iJEPH/article/view/8237

  In patients with unilateral ureteral obstruction, around 1-10% develop acute renal failure. […] The understanding of this process allows to expand the knowledge regarding the mechanism of the damage, the time in which it occurs and its progression.

• #31 Update on the Management of Malignant Ureteral Obstruction – American Urological Association

  https://auanews.net/issues/articles/2023/may-2023/update-on-the-management-of-malignant-ureteral-obstruction

  In conclusion, MUO can be managed with DJS, tandem ureteral stents, reinforced stents, metallic stents, PCN tubes, or extra-anatomical urinary diversion. All have potential downsides, so quality of life effects of each option, frequency of exchanges, and cost of exchange procedures should be taken into consideration. The indication for decompression should be weighed against goals of care and perceived benefits of decompression, such as ability to receive treatment such as chemotherapy or palliation of symptoms related to obstruction.

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