Stenosis Urinary

Decreased peak and mean urinary flow rate (less than 10 to 15 mL/s) on uroflowmetry decreased urinary flow rate is not specific for BPH it can also be due to other urological disorders (e.g., urethral stricture, meatal stenosis, or bladder hypotonicity)... 

Urinary/Gastric retenf/on Administer with caution to patients with clinically significant bladder outflow obstruction because of the risk of urinary retention and to patients with Gl obstructive disorders, such as pyloric stenosis, because of the risk of gastric retention. 

Anticholinergic drugs clearly may cause problems in patients with closed-angle glaucoma (or a narrow angle between the iris and cornea), paralytic ileus, pyloric stenosis, or urinary retention. Because of their effects on temperature control they may be undesirable in patients with pyrexia (especially children) and during very hot weather. 

Used as a screening test, an elevated plasma renin activity after furosemide stimulation or when correlated with urinary sodium excretion can suggest renal artery stenosis as the cause of the hypertension (Figure 51-18). If there is arteriographic evidence for renal artery stenosis, measurement of plasma renin in specimens obtained from selective... 

Focal disease follows a bacteremic phase and involves a wide spectrum of organs. These include liver, gallbladder, aorta (aortic aneurysms), heart valves with stenosis or insufficiency, joints (septic arthritis), bones, urinary tract and soft tissue. The most common serotypes of Salmonella causing focal infection are S. choleraesuis and S. typhimurium. 

Stents are cylindrically shaped devices, which function to hold open and sometimes expand a segment of a blood vessel or other anatomical lumen such as urinary tracts and bile ducts (66). Stents are often used in the treatment of atherosclerotic stenosis in blood vessels. 

Urinary tract Bilateral renal artery stenosis was unmasked by enalapril in a 9-year-old girl with severe hypertension [50 ]. 

Obstruction of the lower urinary apparatus can be caused by primitive lesions of the urethra or lesions secondary to compression by an enlarged prostate or perineal masses. The most frequent cause of non-prostatic obstructive dysuria is acquired stenosis, which can be divided into post-inflammatory, post-traumatic and post-surgical. 

Because of its length, the male urethra is vulnerable to traumatic lesions that may cause acute urinary retention and sudden onset of urethrorrhagia and even late stenosis. Urethral trauma can be divided into external trauma, either contusive or penetrative, and internal or endourethral trauma. Internal traumas usually follow iatrogenic maneuvers. External traumas are frequent events and can occur in the penile urethra as a result of road or work accidents, sporting activities or sex. The urethra can be compressed by subcutaneous or intraspongiosal hematomas and may present complete or incomplete mucosal interruption. 

Hale in 1935 found ectopic kidneys in the offspring of sows on a vitamin A-deficient diet, and Wilson and Warkany showed that considerable malformations of the urinary tract of the offspring could be obtained by placing the mother on this type of diet. In rats they found fused kidneys (see Fig. 15), stenosis of the uterus, homologous genital ducts, and failure... 

Other rare urologic complications of WG include renal artery aneurysms (73,74), renal masses (75,76), necrotizing vasculitis involving the ureters (74), ureteral stenosis (72,77), penile necrosis (73) or ulcers (77), acute urinary retention (72), bladder pseudotumor (77), and involvement of the prostate (3,78). 

Hypospadia is a frequent anomaly of the urinary meatus that can be associated with significant stenosis and dilatation of the male urethra. Though possible in most cases, catheterization of the urethra can be difficult and painful. 

Fig.6.13a,b. US and VCU in a 7-year-old boy with gross hematuria and painful dysuria. a Irregular thickening of the base of the bladder on US. b Elevation of the bladder, irregular stenosis of the bladder neck, and proximal posterior urethra. Prostatic rhabdomyosarcoma was suspected. Cystoscopy and biopsies were negative. Urinary culture was positive. Final diagnosis was E. coli pseudotumoral cystitis... 

Tuberculous involvement of the urinary tract is uncommon. Radiological changes have mainly been described on IVU and include poor definition of a minor calyx or what is called the drooping lily appearance of pyelocalyceal system. It may evolve toward an acquired infundibular stenosis. It is followed by cavitation into the parenchyma. Finally, the kidney may be completely destroyed by ulcero-cavernous caseation and calcify (Cremin 1987). 

Urological problems can be visualized by US in most situations. If requested, isotope studies, CT, or MRI may add valuable information. Severe bleeding around the transplant may be caused by anticoagulation for hemodialysis or a leak of the vessel anastomoses. Hydronephrosis caused by urinary tract obstruction may be the consequence of ureteral kinking, stenosis of ureteral implantation, ureteral necrosis, or large lymphoceles. It is important to note that children with acute renal failure caused by severe urinary obstruction may present with just minimal or moderate renal pelvic dilatation due to a diminished urinary flow (Fig. 21.5). In addition, these situations are painless as the transplant and the ureter have no nerves. Close follow-up is mandatory, especially in patients with bladder dysfunction or an augmented bladder. 

---