Urinary Tract Obstruction

Frøkiær, Jørgen; Zeidel, Mark L.

doi:10.1016/b978-1-4160-6193-9.10037-5

Cited by 19 publications

(36 citation statements)

References 228 publications

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“…13 One explanation for this apparent inconsistency is that since hydronephrosis may not be present if obstruction is detected early, it may be an indicator of a more severely decompensated collecting system. 4 Moreover, severe hydronephrosis may favour initial decompression, which accounted for less than a quarter of all interventions within our population. Lastly, the presentation of LRs, unlike logistic regression as used in our study, does not account for potential confounders and assumes a normal distribution of the data.…”

Section: Discussionmentioning

confidence: 95%

“…UTO has been associated with kidney parenchymal injury and may compromise renal function if there is bilateral obstruction or if the contralateral kidney is unable to compensate for the obstructed renal unit. 4,5 In addition, UTO may increase the risk of urosepsis, an indication for urgent decompression. 2 Lastly, obstructing stones may be associated with a longer duration of pain.…”

Section: Introductionmentioning

confidence: 99%

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Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

Massaro

Atkinson

Pawsey

et al. 2017

CUAJ

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Introduction: Our objective was to determine whether unilateral calculus-induced ureteric obstruction on computed tomography (CT) was independently associated with the need for urological intervention and 30-day return to the emergency department (ED). Methods:We performed a retrospective cohort study of patients with symptomatic urinary calculi diagnosed by unenhanced helical CT. Stepwise regression analysis was used to determine the predictors of urological intervention and 30-day return to the ED. Potential predictors assessed included: patient demographics, calculus size, calculus location, degree of obstruction, analgesic doses, signs and symptoms of infection, serum creatinine, cumulative intravenous fluid administered, and the prescription of medical expulsive therapy. Results: Of 195 patients, 81 (41.5%) underwent urological intervention. The size of the calculus, its location, and the cumulative opioid dose were all independent predictors for urological intervention. Every 1 mm increase in calculus size increased the likelihood of intervention 2.2 times (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.67-2.85). Proximal stones were 4.7 times more likely to require intervention than distal calculi (OR 0.21; 95% CI 0.09-0.49). Every 10 mg increase in morphine was associated with a 30% increase in the odds of intervention (OR 1.30; 95% CI 1.07-1.58). Degree of obstruction was not associated with the need for urological intervention. Finally, none of the variables were predictors for 30-day return to the ED. Conclusions: Although stone size, proximal location, and severe pain, as indicated by higher opioid doses, were associated with the need for intervention, the degree of obstruction did not influence the management of patients with CT-defined urinary calculi.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

Massaro

Atkinson

Pawsey

et al. 2017

CUAJ

View full text Add to dashboard Cite

show abstract

“…Common causes of lower tract obstruction include benign prostatic hypertrophy (BPH), prostate cancer, and urinary retention as seen with neurogenic bladder. 2,61,62 In elderly men, BPH remains the most common cause of acute urinary retention. In addition, urinary retention can also occur from neurologic interruption of bladder tone as seen in spinal cord injuries, diabetic neuropathy, and patients with cerebrovascular accidents.…”

Section: Post-renal Acute Kidney Injurymentioning

confidence: 99%

“…If nephrolithiasis is suspected, noncontrast CT can reveal the anatomic location and severity of disease. 2,61 Early identification and treatment of post-renal AKI is essential because relief of obstructive causes often results in recovery of renal function.…”

Section: Post-renal Acute Kidney Injurymentioning

confidence: 99%

“…Renal ultrasonography or noncontrast CT imaging can help to evaluate upper urinary tract obstructions such as nephrolithiasis. 61,62 Laboratory Data Common laboratory and urine results used to help differentiate among different category of AKI are outlined in Table 2. Serum creatinine and blood urea nitrogen are the usual starting points for the evaluation of AKI.…”

Section: History and Clinical Evaluationmentioning

confidence: 99%

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