Scribd Logo
Upload

Welcome to Scribd!

  • 102 views

    The 'Ins' and 'Outs' of Ureteric Obstruction

    Uploaded by

    The Kidney Club
    The document discusses the evaluation and management of ureteric obstruction. It describes how to establish if a ureter is obstructed using imaging and nuclear renography. Management considerations include determining the cause, level, and length of obstruction, as well as the condition of the kidney and bladder. Short-term strategies include stenting or nephrostomy, while long-term plans involve treating the underlying cause or various reconstructive procedures. Specific situations like obstructed infected systems or upper tract urothelial cancer are also reviewed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    The 'Ins' and 'Outs' of Ureteric Obstruction

    Uploaded by

    The Kidney Club
    102 views65 pages
    The document discusses the evaluation and management of ureteric obstruction. It describes how to establish if a ureter is obstructed using imaging and nuclear renography. Management considerations include determining the cause, level, and length of obstruction, as well as the condition of the kidney and bladder. Short-term strategies include stenting or nephrostomy, while long-term plans involve treating the underlying cause or various reconstructive procedures. Specific situations like obstructed infected systems or upper tract urothelial cancer are also reviewed.

    Original Description:

    Rajan Veeraterapillay presented to The Kidney Club on the 9th September 2020

    Original Title

    The 'ins' and 'outs' of ureteric obstruction

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document discusses the evaluation and management of ureteric obstruction. It describes how to establish if a ureter is obstructed using imaging and nuclear renography. Management considerations include determining the cause, level, and length of obstruction, as well as the condition of the kidney and bladder. Short-term strategies include stenting or nephrostomy, while long-term plans involve treating the underlying cause or various reconstructive procedures. Specific situations like obstructed infected systems or upper tract urothelial cancer are also reviewed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    102 views65 pages

    The 'Ins' and 'Outs' of Ureteric Obstruction

    Uploaded by

    The Kidney Club
    The document discusses the evaluation and management of ureteric obstruction. It describes how to establish if a ureter is obstructed using imaging and nuclear renography. Management considerations include determining the cause, level, and length of obstruction, as well as the condition of the kidney and bladder. Short-term strategies include stenting or nephrostomy, while long-term plans involve treating the underlying cause or various reconstructive procedures. Specific situations like obstructed infected systems or upper tract urothelial cancer are also reviewed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 65

    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

     How to establish the diagnosis

     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

    Hydronephrosis with a clear mechanical


    cause on imaging +/- AKI

    MAG3 renogram
    Management considerations
    What is the cause?

    What it the ‘level’ & ‘length’ of


    obstruction?

    What does the kidney and bladder look


    like?

    What is my short-term strategy?

    What is my long-term plan?

    Are the specific patient factors to


    consider?
    What is the cause?
    ‘In the lumen, In the wall, On the outside’
    What it the ‘level’ & ‘length’ of
    obstruction?
    What does the kidney and
    bladder look like?
    What is my short-term
    strategy?
    Ureteric stenting Immediate reconstruction

    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

    Urinary tract reconstruction No intervention


    Specific situations
    Obstructed Infected system

    Needs urgent decompression


    PUJ Obstruction
    Ureteric stone management
    Ureteric stone management

    Endourological with flexi URS


    and holmium laser

    Stent and come back another


    day

    Occasional role for open


    surgery
    Upper Tract Urothelial cancer
    management
    Low risk UTUC – endoscopic treatment (or segmental resection)

    High risk UTUC - nephroureterectomy


    Benign ureteric stricture management
    Endourological management good for short strictures and patients not
    suitable for urinary tract reconstruction
    Reconstruction – stricture excision and re-anastomosis
    Reconstruction – psoas hitch and ureteric reimplant
    Reconstruction – Boari flap and ureteric reimplant
    Reconstruction – Ileal ureter
    Reconstruction – Transureteroureterostomy
    Malignant ureteric obstruction
    Surgically resectable
    disease

    Metastatic disease
    Surgically resectable disease
    Surgically resectable disease
    Surgically resectable disease
    Surgically resectable disease
    Metastatic disease

    Stents or nephrostomies (likely long term)

    Facilitates chemotherapy

    Is this necessary?

    Get an idea of prognosis before intervention


    Retroperitoneal fibrosis
    Consider biopsy

    Ureteric stents / steroids

    Stent removal if good repsonse

    Ureterolysis
    Summary

     Urgently drain an infected obstructed system

     Think of short and long-term plan prior to intervention

     Multiple strategies available tailored to individual case

     Structure & function assessment vital


    [email protected] @rajan_vpillay

    @NewcastleUrolo1

    You might also like