0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59
Upper Urinary Tract Obstruction 1487
IVU, CT urogram or retrograde pyelogram: obstruction at level
of L3–4 where ovarian vein crosses ureter
CT: ovarian vein crosses at level of obstructed ureter
■Iatrogenic injury
➣IVU, CT or retrograde pyelogram: show point of obstruction
management
What to Do First
■Urgent decompression of collecting system in cases of obstruction
associated with clinical signs of infection (ureteral stent or percuta-
neous nephrostomy tube)General Measures
■Acute renal colic
➣Hydration
➣Pain relief with narcotic analgesics
➣Decompression of collecting system (ureteral stent or percuta-
neous nephrostomy tube) for pain control
■Endoscopic inspection (ureteroscopy) if diagnosis not established
with imagingspecific therapy
Intrinsic Obstruction
■Ureteral stone (see Urolithiasis)
■Ureteral tumor
➣Endoscopic resection or laser ablation
➣Surgical resection (nephroureterectomy, segmental resection)
■Sloughed papilla
➣Antimicrobial agents if infection-related
➣Cessation of analgesics if analgesic abuse
➣Endoscopic retrieval of sloughed papilla for persistent obstruc-
tion
■Fungus ball
➣Systemic antifungal therapy (amphotericin B, fluconazole)
➣Nephrostomy drainage
➣Intra-renal irrigation with amphotericin B
■Ureteral stricture
➣Endoscopic incision or balloon dilation
➣Laparoscopic or open surgical reconstruction
Extrinsic Obstruction
■Segmental resection of ureter may be necessary