Obstructive Uropathy

It has often surprised me that in order to study the subject of obstructive uropathy, it is necessary to search through various sections of several urological, surgical and radiological textbooks rather than turn to one work on the subject. It is also true that, even now, many descriptions tend to concentrate on the causative conditions rather than their relationship to the proximal outflow tract, in a way which is predominantly structural and anatomical rather than functional and urodynamic. The subject of obstructive uropathy has changed radically in recent years. Inspired research from several centres has given us great insight into the mechanisms of obstruction and its effects on the outflow tract and nephron. It has been accompanied by the development of new methods of investigation in both the experimental and the clinical field. This book is an attempt to update and distill the subject of obstructive uropathy in one volume. For the purpose of the work, obstructive uropathy is taken to include any condition involving the outflow tract of the kidney, from minor calyces to urethra, which results in obstruction to the flow of urine. Emphasis is on physiology and pathophysiol­ ogy, function and urodynamics. These considerations should not be thought of as purely theoretical. Far from it. They hold the key to subsequent decisions on diagnosis and management and form the basis for a practical approach to the patient with obstruction. The only details the reader will not find here are descriptions of surgical technique.

Upper Urinary Tract Obstruction.- 1 Introduction and General Considerations.- Normal Urinary Tract.- Obstructed Urinary Tract.- Renal Pelvic Pressures in Obstruction.- Renal Blood Flow in Obstruction.- Glomerular Filtration Rate in Obstruction.- Tubular Function in Obstruction.- Relief of Obstruction.- Causes of Obstruction.- Investigation of Obstruction.- 2 Laboratory Investigations.- Biochemistry.- Plasma Urea.- Plasma Creatinine.- Creatinine Clearance.- Osmotic Pressure.- Concentrating Ability.- Urine Acidification.- ?2 Microglobulin Estimation.- Microbiology.- Collection of Specimens.- Investigations.- Interpretation of Results.- 3 Radiology.- Intravenous Urography.- Diuresis Urography.- Retrograde Pyelography.- Retrograde Ureteric Intubation.- Lower Tract Obstruction.- Ultrasound.- Computed Tomography.- 4 Nuclear Medicine.- Radiopharmaceuticals.- Radionuclide Renography.- Radionuclide Investigation of Renal Disease.- Clinical Applications.- Summary.- 5 Antegrade Percutaneous Studies.- Antegrade Pyelography.- Perfusion Pressure Flow Studies.- 6 Urinary Stone Disease.- 7 Idiopathic Hydronephrosis (Pelviureteric Junction Obstruction).- 8 Ureteric Obstruction.- Retroperitoneal Fibrosis.- Urothelial Tumours.- Ureteric Strictures.- Congenital Strictures.- Tuberculous Strictures.- Bilharzial Strictures.- Iatrogenic Strictures.- Radiation Strictures.- Malignant Strictures.- Balloon Dilatation.- Congenital Ureteric Anomalies.- Primary Megaureter.- Retrocaval Ureter.- Ureteric Duplication.- Ureterocele.- Miscellaneous Causes of Ureteric Obstruction.- Horseshoe Kidney.- Vascular Anomalies.- Endometriosis.- Procidentia.- Pregnancy.- Crohn’s Disease.- Inflammatory Bowel Disease.- Primary Megacalycosis.- Malacoplakia.- Pelvic Lipomatosis.- Renal Transplantation.- Urinary Diversions.- 9 Percutaneous Renal Surgery in Obstructive Uropathy.- Percutaneous Nephrolithotomy.- Percutaneous Pyeloplasty.- Lower Urinary Tract Obstruction.- 10 Basic Considerations.- The Nature of Obstruction and its Relationship to Functional Abnormality of the Urinary Tract.- Clinical Assessment of Functional Performance in the Lower Tract.- Urodynamic Assessment.- Anatomical Assessment.- Residual Urine Assessment.- Histological Assessment.- Sensory (Symptomatic) Assessment.- Comparative Studies.- Micturition Cycle.- Symptoms and Signs of Lower Tract Obstruction.- Examination and Investigation of the Obstructed Patient.- 11 Obstructive and Functional Abnormalities I.- Classification of Functional Disorders on the Basis of Residual Urine.- Age-Related Changes and the Lower Urinary Tract.- Acute (Painful) Retention.- High-Pressure Chronic Retention.- Low-Pressure Chronic Retention.- High-Pressure Voiding.- Low-Pressure Voiding.- Comparative Studies in Painless Retention.- Incidence of the Disorders Associated with Residual Urine.- 12 Obstructive and Functional Abnormalities II.- Bladder Dysfunction Without Residual Urine.- Bladder Neck Obstruction.- Underactive Bladder Neck Dysfunction.- Comparative Studies in Bladder Neck Dysfunction.- Summary of Bladder Neck Dysfunction.- Overall View of the Dysfunctional States of the Lower Urinary Tract, Their Relationship to One Another and to the Voiding Dynamics of Normal Persons.- Obstructive Uropathy in Females.- Acute Retention of Urine.- High-Pressure Chronic Retention.- Low-Pressure Chronic Retention/Low-Pressure Voiding.- Obstructive Uropathy in Children.- Acute Painful Retention.- High-Pressure Chronic Retention.- Bladder Neck Obstruction.- Low-Pressure Voiding Dysfunction.- 13 Practical Aspects of the Management of Lower Urinary Tract Obstruction.- Bladder Neck Dysfunction.- Urethral Valves.- Prostatic Hypertrophy.- Carcinoma of the Prostate.- Urethral Stricture.