The 'Ins' and 'Outs' of Ureteric Obstruction
The 'Ins' and 'Outs' of Ureteric Obstruction
The 'Ins' and 'Outs' of Ureteric Obstruction
Mr Rajan Veeratterapillay
MBBS MRCS FEBU FRCS(Urol)
Consultant Urological Surgeon
Freeman Hospital,
Newcastle Upon Tyne, UK
[email protected]
@rajan_vpillay
Outline
Management considerations
Specific situations
Abdominal ureter - relations
Pelvic ureter - relations
Male Female
Female
Establishing if a ureter is obstructed
Hydronephrosis ≠ Obstruction
CT IVU
MAG3
Renogram
Establishing if a ureter is obstructed
MAG3 renogram
Management considerations
What is the cause?
Primary endourological
Nephrostomy
management
No intervention
Stents
Internal drainage
Usually requires GA
Stent symptoms
Require regular changes
Nephrostomies
External drainage bag with QOL implications
Can be done under LA
Require regular changes
?Better if severe obstruction
What is my long-term strategy?
Treatment of underlying
cause
Endourological
management
Metastatic disease
Surgically resectable disease
Surgically resectable disease
Surgically resectable disease
Surgically resectable disease
Metastatic disease
Facilitates chemotherapy
Is this necessary?
Ureterolysis
Summary
@NewcastleUrolo1