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Diagnostic Approach to Acute Kidney Injury in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Sonali Gupta, Divyansh Bajaj, Sana Idrees, Joseph Mattana
There are many conditions that may result in urinary tract obstruction, with prostatic disease being a common etiology in older men. While a review of all causes of urinary tract obstruction is beyond the scope of this review, there are several important clinical caveats to keep in mind. One is that prompt diagnosis followed by early relief of obstruction is associated with improvement in renal function in most and that delayed recognition may result in permanent renal damage. Fortunately, obstruction can usually be readily diagnosed by ultrasonography or computed tomography. However, some cases of obstruction may not be associated with a dilated urinary tract, such as with retroperitoneal hemorrhage or lymphoma involving the retroperitoneum, and hence, in the appropriate setting when there is a high index of suspicion for obstruction, a negative renal ultrasound should not preclude further investigation. Another important point to remember is that while complete obstructions will cause anuria, most obstructions are partial, and urine output may be preserved, and hence, the absence of oliguria or anuria should not by itself be considered sufficient to rule out urinary tract obstruction.
The urinary tract and male reproductive system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Luis Beltran, Daniel M. Berney
Obstruction in the urinary tract may be acute or insidious in onset and, if unrelieved, will cause significant renal damage resulting in acute or chronic renal failure. It may be intermittent or complete and may be unilateral or bilateral. Urinary tract obstruction can occur at any level of the urinary tract from the urethra to the renal pelvis and may be caused by either lesions intrinsic to the urinary tract or by extrinsic lesions causing compression. The most common causes of urinary tract obstruction are summarized in Box 17.1. Urinary tract obstruction predisposes to urinary tract infection and to urinary calculus formation.
The renal system
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
Obstructive uropathy is a general term that refers to conditions that obstruct the outflow of urine (see Figure 10.9). Causes of urinary tract obstruction include stricture of the urethra or ureters, prostatic hypertrophy, and pelvic organ prolapse. When outflow is obstructed from the bladder urine can back up and accumulate in the ureters and lead to their distention. This condition is called hydroureter. Prolonged obstruction of urine outflow can cause urine to back up and accumulates in the spaces (pelves and calyces) of the kidney. This is condition is called hydronephrosis. The presence of hydronephrosis is more serious than hydroureter because the increased pressure in the renal capsule caused by hydronephrosis can rapidly damage functional structures in the kidney.
Clinical Presentations and Diagnostic Imaging of VACTERL Association
Published in Fetal and Pediatric Pathology, 2023
Gabriele Tonni, Çağla Koçak, Gianpaolo Grisolia, Giuseppe Rizzo, Edward Araujo Júnior, Heron Werner, Rodrigo Ruano, Waldo Sepulveda, Maria Paola Bonasoni, Mario Lituania
Renal anomalies occur in approximately 50-80% of patients with VACTERL association [32,33]. The renal abnormality spectrum ranges from renal agenesis to horseshoe kidney and MCDKD, which may be also associated with limb defects such as oligodactyly of the foot [50] (Figures 11 and 12), and crossed renal ectopia may be seen (Figures 13 and 14). In some studies, the most common renal manifestation seen in patients with VACTERL association is renal agenesis [51,52] (Figures 15 and 16). In a cohort study conducted by Cunningham et al. [53], vesicoureteral reflux (VUR) in addition to a structural defect was the most common renal anomaly, followed by renal agenesis. Stenosis of the urethra with an enlarged bladder, resembling lower urinary tract obstruction, can also be observed [54]. Urinary anomalies represent a series of diseases capable of causing major morbidity, some of which can be life-threatening. These anomalies often go unrecognized or overlooked, affecting the child’s growth and the future chance of transplant success [55]. In the postnatal period, examination with a voiding cystourethrogram may be required in cases with VUR [5]. Renal agenesis can be diagnosed using US and/or MRI. Renal agenesis and renal artery absence, hypertrophy of the contralateral kidney on US, and MRI with the ipsilateral adrenal gland “lying-down” in the pelvis are recognized MRI diagnostic clusters [56].
Dynamic prostatic and laser-ablated lesion volume change after transperineal laser ablation in canine: preliminary observation and its clinical significance
Published in International Journal of Hyperthermia, 2020
Rui-Qing Liu, Ji-Bin Liu, Shao-bo Duan, Si-Guo Cheng, Zhi-Yang Chang, Hui-cun Cao, Guang-Shao Cao, Ya-Qiong Li, Na Li, Lian-Zhong Zhang
Previous literature reported that the application of laser in benign prostate hyperplasia (BPH) mostly focused on the transurethral approach [14], which may result in retrograde ejaculation and complications, such as hematuria and urinary retention, while urethral and bladder neck strictures still occur. Transperineal laser ablation (TPLA) is a novel option for minimally invasive treatment of benign prostatic obstruction [15,16]. TPLA could be performed under local anesthesia. Besides, the transperineal approach avoids damage to the urethral channel. Approximately 50% of men over 50 years of age will show pathological evidence of BPH, and this number increases to 80% in men with an age of more than 80 years old [17]. BPH is a common cause of lower urinary tract obstruction in men, which reduces the quality of life [18]. The symptoms of lower urinary tract obstruction in patients who underwent TPLA were significantly relieved at 3 and 6 months [19]. However, previous studies have reported that the laser-ablated volume in liver tumors has increased immediately after the laser ablation operation [20,21]. Little is known about the volume change of prostate and laser-ablated lesions in a short time after TPLA. The transient enlargement of prostate volume will result in acute urinary retention. The catheterization time for patient underwent prostatic focal therapy varied from 1 to 15 days [19,22].
Management of staghorn renal stones
Published in Renal Failure, 2018
Staghorn stones are large and branching stones that fill part or all of the pelvicalyceal system. They are usually unilateral and less common in men. They are linked to urease-producing bacterial infections and, hence, known as struvite infection stones.Urinary tract obstruction, long-term urethral catheter, previous urinary diversion, and neurogenic bladder are well-recognized predisposing factors.Recent increase in metabolic component of staghorn stones is noticed with calcium phosphate being the most common. However, no clear etiological explanation is available.Untreated staghorn stones are detrimental to the kidney and treatment objectives are complete stone removal, successful treatment of the causative bacteria, preserving renal function and prevention of stone recurrence.PCNL should be the recommended first-line treatment for staghorn stones. Other surgical and non-surgical treatment options can be considered as a multimodal therapy or separately in certain circumstances.Although measures to prevent staghorn stone recurrence are currently available, their clinical utility is under debate, suggesting further research.