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Urinary tract obstruction 

Urinary tract obstruction
Chapter:
Urinary tract obstruction
Author(s):

Muhammad M. Yaqoob

, and Kieran McCafferty

DOI:
10.1093/med/9780198746690.003.0507
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date: 27 February 2021

Obstructive nephropathy can manifest as either a sudden or an insidious decline in renal function, which can be halted or even reversed by relief of obstruction. Obstruction can be due to anatomical or functional abnormalities of the urethra, bladder, ureter, or renal pelvis, which may be congenital or acquired, and it can also occur as a consequence of diseases extrinsic to the urinary tract. Although dilatation of the outflow system proximal to the site of obstruction is a characteristic finding, widening of the ureter and/or pelvicalyceal system does not necessarily indicate the presence of obstruction, and flow may be obstructed without such dilatation. Aetiology—calculi and pelviureteric junctional obstruction are common causes of unilateral obstruction, while prostatic enlargement, stone disease, and bladder and pelvic tumours account for about 75% of cases of bilateral obstruction in developed countries. To the clinician, the first and most important question is whether urinary tract obstruction is of recent onset (acute obstruction) or long-standing (chronic obstruction). The pathophysiological changes, clinical features, approach to investigation, and management differ in important respects in these two circumstances, which are discussed separately in this chapter under the headings of acute upper urinary tract obstruction, acute lower urinary tract obstruction, chronic upper urinary tract obstruction, and chronic lower urinary tract obstruction. Retroperitoneal fibrosis, a rare condition, is also discussed.

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