wds obstruksi upper tract trigonum 2002

7/25/2019 WDS Obstruksi Upper Tract Trigonum 2002

1/21

01/23/16

Upper Tract

ObstructionWahjoe Djatisoesanto

Dept. of Urology

Airlangga University Dr.Soetomo Hospital


2/21


3/21

01/23/16

ACUTE OBSTUCT!O"

ET!O#O$%

& Stone

& Slo'ghe( renal papillae

& Bloo( )lot

&A)'te retroperitoneal pathology& A))i(ental 'reteri) ligation


4/21

01/23/16

ACUTE OBSTUCT!O"

*ATHO*H%S!O#O$%

& !ntrarenal press're

& enal +loo( ,o- B/0

& $lomer'lar 1ltration rate $/0

& T'+'lar f'n)tion

& O+str')tive atrophy


5/21

01/23/16

S%2*TO2S 3 S!$"S

& Asymptomati) in)i(ental0

& Symptoms4

A)'te or )hroni) Uni or +i5lateral

!n or e65trinsi)

Complete or partial

/lan7 pain

"a'sea8 vomiting8 fever8 )hilling8 an'ria


6/21

01/23/16

!"TA E"A# *ESSUE

Ti() C'**.%!%#.+r)%%&r) RBF

P,%) I 0 - 0 (in.

P,%)II 0 (in - ,

r)(in% )*)#)4 #' $)*'5 "'n#r'*4

P,%) III - 1 ,

#' r)%#in74 "'n#.)"r)%)4


7/21

01/23/16

B!O2ECHA"!CS O/ UETE!COBSTUCT!O"

#a- of #apla)erelationship +et-een intral'minal press're8 vol'me 3 tension in the

-all of a )ompliant homogeneo's sphere 'n(er e9'ili+ri'm)on(itions

P.8.R9 T.;8.R

Si(+*i?i): P.R 9 T.2.R.).


8/21

01/23/16

U**E TACT OBSTUCT!O"

!":EST!$AT!O"

;. !:*

. CT


9/21

01/23/16



10/21

01/23/16


!":EST!$AT!O"

;. !:*

. CT


11/21

01/23/16



12/21

01/23/16


!":EST!$AT!O"

;. !:*

. CT


13/21

Fi7&r) : T,) )??)"# '? '$%#r&"#i'n 'n #,) r)n'7r( "&r). A (i* '$%#r&"#i'n

$ (')r#) '$%#r&"#i'n" ,i7,=7r) '$%#r&"#i'n.


14/21

01/23/16

U"E?U!:OCA# CHO"!C OBSTUCT!O"

*athophysiology

& O+str')tion high i.r.press. fall " range0

& B/ (e)lines pre o+st.level after =5> h (e)lining tothe ne-8 re(')e( level

& $/ falls progressive

& T'+'lar f'n)tion a@e)te( hypotoni)

& Urinary osmolality 3 "a )ontent in)rease(


15/21

01/23/16

U"E?U!:OCA# CHO"!C OBSTUCT!O"

*rimary mega 'reter

etro)aval 'reter

etroperitoneal 1+rosis

Urothelial t'mor

Ureteri) stone

Ureteri) stri)t're

Congenital

T'+er)'losis

Bilharial

!atrogeni)a(iation

etroilia) 'reter

Ovarian vein syn(romeEn(ometriosisE6trinsi) o+str')tion

Bo-el malignan)ies e.g. )olon0*elvi) malignan)ies e.g.)ervi60

*regnan)yUretero)eleBla((er )an)er2ala)opla7iaB*H*rostate Ca

*ro)i(entia*elvi) lipomatosisUrethral stri)t're*himosis


16/21

01/23/16

E?U!:OCA# CHO"!C OBSTUCT!O"

U* stenosis

*rimary mega'reter

:U stenosis

Urinary (iversion

Apparent 'reteri) stri)t're

*regnan)y

!nfe)tive (ilatation

D'pli)ation

*revio's s'rgery4'reterolithotomyre5implantationpyelopasty

*revio's en(o'rology4'reteros)opy+as7etry


17/21

01/23/16


G In(i)ations of emergen)y (rainage

&Types of 'rinary (rainage

& Consi(erations in4

type of the pro)e('re

timing

& Case presentation


18/21

01/23/16


&Types of emergen)y (rainage

E6ternal4

"ephrostomy& Open

& *er)'taneo's *"S0

!nternal& Do'+le5 stenting


19/21

01/23/16


& Consi(erations in4

type of the pro)e('re

& Degree of (ilatation

& *atient )on(ition 555 positioning

& #o)al or generalregional anesthesia& Drainage only or (e1nitive treatment

timing


20/21

01/23/16


& !n(i)ations of emergen)y (rainage

O+str')tive an'ria

Urosepsis )a'se( +y

& *yonephrosis

& !nfe)te( Hy(ronephrosis


21/21

01/23/16

CO"C#US!O"

& Upper Tra)t O+str')tion may +e a)'te or)hroni)8 'ni or +ilateral8 'ne9'ivo)al ore9'ivo)al

& Une9'ivo)al (iagnose( +y imaging te)hni9'e

& E9'ivo)al o+str')tion re9'ires f'n)tional an('ro(ynami) assessment

& Emergen)y (rainage is in(i)ate( -hen thereare o+str')tive an'ria an( pyonephrosis

& Hemo(ialysis is nee(e( if in(i)ate( an( sho'l(+e (is)'sse( appropriately

wds obstruksi upper tract trigonum 2002

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