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Management of
Upper Urinary Tract
Obstruction
By: Ismah Haron
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
Source: http://www.mountnittany.org
Source: http://radiographics.rsna.org
Source:
http://www.insideradiology.com.au
Reduce the symptoms:
Treat underlying cause:
• Analgesic
• Antipyretic
• Antibiotic
Stones
• Pass spontaneously
• Extra-corporeal shockwave lithotripsy
• Percutaneous nephrolithotomy
• Endoscopic treatment - ureteroscope
• Open nephrolithotomy/ureterolithotomy
• Prevention from recurrence
Source: http://www.emedicinehealth.com
ESWL
Source: http://www.emedicinehealth.com
PCNL
Source: http://www.emedicinehealth.com
Endoscopic treatment
• Prevention from recurrence;
- Increase fluid intake
- Reduce Ca intake
- Correct metabolic abnormalities
- Treat infection
- Urinary alkalization
THANK YOU

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Informed Consent Empowering Healthcare Decision-Making.pptx
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management of upper urinary obstruction

Editor's Notes

  1. http://emedicine.medscape.com
  2. Ureteral stent
  3. 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.
  4. Illustration of a nephrostomy tube and drainage bag
  5. 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
  6. ESWL
  7. Percutaneous nephrolithotomy
  8. Uteroscope