Internal Medicine

0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59

1488 Upper Urinary Tract Obstruction Urethritis

■Retroperitoneal fibrosis

➣Steroids with or without tamoxifen

➣Ureterolysis and intraperitonealization of the ureters

■Iatrogenic ureteral injury

➣Deligation of ureter with or without placement of a ureteral stent

➣Ureteral resection

follow-up

■IVU, sonography or CT to assure resolution of obstruction and the

underlying pathology

complications and prognosis

Complications

■Pyonephrosis and/or urosepsis

➣Prompt decompression of the collecting system

➣Initiation of broad-spectrum antibiotics

■Post-obstructive diuresis: loss of urinary concentrating ability

■Physiologic diuresis: self-limited, normal thirst mechanism main-

tains sufficient fluid replacement

■Pathologic diuresis (elevated BUN/Cr, signs of volume overload):

supplement with intravenous 0.45% saline, matched^1 / 2 cc per cc

urine output

■Loss of renal function

■Hypertension

➣Unilateral ureteral obstruction: in rare cases, renovascular hyper-

tension is associated with obstruction

➣Bilateral ureteral obstruction: usually resolves with resolution of

obstruction and diuresis

Prognosis

■Depends on degree and duration of obstruction

URETHRITIS

JAMES W. SMITH, MD and DANIEL BRAILITA, MD

history & physical

History

■History of urethral discharge may vary from significant to scanty.

■The discharge may be purulent, mucopurulent or clear.

■It may be noted continuously throughout the day or only with the

first voiding in the morning.