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Obstructive Disorders

Hydronephrosis, hydroureter, and urethral stricture

 

Hydronephrosis>kidney enlarges+urine collects in pelvis/kidney tissue [capacity of renal pelvis is 5-8ml];

kidney pressure↑ as vol of urine↑];renal tubules + blood vessels damaged extensively in matter of hours

Hydroureter:Enlargement of ureterObstruction is lower in urinary tract.

Ureter dilation occurs above obstruction and enlarges as urine collectsUrethral stricturesObstruction very low in urinary tract causing bladder distention before hydroureter and hydronephrosis

Glomerular filtration ↓ or ceasesNitrogenous wastes(urea, creatinine, and uric acid) and electrolyte(Na,K,Cl,Phosphorus) are retained in blood>electrolyte inbalanceCauses: tumors, stones, trauma, congenital structural defects, fibrosis

Permanent damage can occur in ↓48 hrs in some clients and after weeks in others

 

ASSESSMENT

Inspect each flank to identify asymmetry(renal mass) and gently palpate+percuss to detect distention

Gentle pressure on abdomen may cause urine leakage which reflects a full bladder and possible obstruction

Blood creatinine and BUN↑ w glomerular filtration rate↓Hyperkalemia, hyperphosphatemia, hypocalcemia,metabolic acidosis(bicarb deficit)

INTERVENTIONS

If stricture is caused by a stone: Pyelogram procedure: urologisy uses cytoscope 2 guide stone basket over stone and remove it through bladder; stent left to improve urine flow for few weeks, then removedIf stricture is causing problem>nephrostomy(diverts urine externally)NPO 4-6 hrs preopClotting studies(INR,PT,PTT) should be normal or corrected

Moderate sedation

Prone position

Needle placed into kidney , soft tipped guidewire is placed through needle and catheter placed over wireCatheter tip remains in renal pelvis and external end is connected to drainage bagProcedure immediately relieves pressure in kidney

Postop: amount of drainage depends on if a ureteral catheter is also being used(with a separate drainage bag)Clients w ureteral tubes may have all urine pass through to bladder or may have urine drain into the collection bagAsses amount drained hourly for 1st 24hrs If amount of drainage↓ and client has back pain, tube may be clogged or dislodgedUrine drainage may be red tinged for 1st 12-24 hrs postop

 

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