Ureteral obstruction

Bilateral orchiectomy, or removal of the testes, rapidly reduces circulating androgens to castrate levels (andro-stenedione less than 50 ng/mL, 1.7 nmol/L).15 However, many patients are not surgical candidates owing to their advanced age, and other patients find this procedure psychologically unacceptable.15 Orchiectomy is the preferred initial treatment in patients with impending spinal cord compression or ureteral obstruction. 

Nephrostomy Insertion of a catheter through the skin into the renal pelvis to bypass ureteral obstruction and facilitate urine drainage. 

Prishchepa LA, Burdyga TV, Kosterin SA 1996 Two components of sodium azide-insensitive Mg2+, ATP-dependent Ca2+ transport in ureteral smooth muscle membrane structures (translated from Russian). Biokhimiia 61 1250—1256 Rose JG, Gillenwater JY 1973 Pathophysiology of ureteral obstruction. Am J Physiol 225 830-837... 

Greiner R, Skaleric C, Veraguth P. The prognostic significance of ureteral obstruction in carcinoma of the bladder. Int J Rad Oncol Biol Phys 1977 2 1095-1100. 

Some adverse reactions lead to organ fibrosis for instance in the lungs, peritoneum or of mucous membranes in Stevens-Johnson syndrome. Then other treatments of these conditions may be needed which can include even surgery, for example, to free ureteric obstruction or to correct vaginal stenosis. 

Ureteral obstruction and spinal cord compression have been observed. An immediate orchiectomy may be necessary if these conditions occur. 

Ishidoya et al. (1995), Klahr and Morrissey (1997) induced interstitial renal fibrosis by unilateral ureteral obstruction in Sprague Dawley rats and tested the effect of ACE inhibitors and angiotensinll receptor antagonists. 

Hartenbower DL, Coburn JW (1972) A model of renal insufficiency in the chick. Lab Anim Sci 22 258-261 Ishidoya S, Morrissey J, McCracken R et al. (1995) An-giotensinll receptor antagonist ameliorates renal tubulointerstitial fibrosis caused by unilateral ureteral obstruction. Kidney Intern 47 1285-1294 Klahr S, Morrissey JJ (1997) Comparative study of ACE inhibitors and angiotensinll receptor antagonists in interstitial scarring. Kidney Intern 52, Suppl 63 111-114 Sancho JJ, Duh Qy, Oms L et al. (1989) A new experimental model for secondary hyperparathyroidism. Surgery 106 1002-1008... 

Zwergel et al. (1991) developed an intact canine model to measure renal pelvic pressure after complete ureteral obstruction with a balloon catheter inflated in the distal ureter. 

A 39-year-old patient, Mrs DS, known to urology (as had left ureteric obstruction which was stented), presents with back pain and lower left-sided abdominal pain with rigors and nausea. She has lost 2 stone (12.7 kg) in weight and cannot work. 

The laboratory results support the clinical signs and symptoms. A raised serum urea and creatinine are likely to be the result of ureteric obstruction caused by the retroperitoneal mass. The reduction in renal function is confirmed by the low EDTA clearance (an approximation of glomerular filtration rate) of 57 mL/min. 

A patient who grossly overused an antacid containing aluminium and magnesium developed nephrolithiasis and bilateral ureteric obstruction as well as asymptomatic hypophosphatemia (SEDA-16, 417). 

Some adverse effects are associated with all antifibrinolytic agents, reflecting their effect on clot stability. Dissolution of extravascular blood clots may be resistant to physiological fibrinolysis. These drugs should not to be used to treat hematuria due to blood loss from the upper urinary tract, as this can provoke painful clot retention and even renal insufficiency associated with bilateral ureteric obstruction (25-31). 

In 1983, Godec and Gleich reviewed all published results of treatment of intractable hematuria with formalin. Dilutions of 1-10% formalin (containing 0.37-3.7% formaldehyde) were used the most commonly used concentration of formalin was 10%. The authors concluded that formalin was probably the most effective tool for controlling massive hematuria, but also probably the most dangerous. The review covered 23 articles and 118 patients in 104 cases, treatment was successful. However, in only 10 reports had the treatment been used without serious adverse effects the other 13 articles listed four deaths and many serious local and systemic complications. The complication rate increased when the formalin concentration was higher, but the contact time and the volume instilled did not influence the occurrence of adverse effects. The most frequent local complications were reflux and hydronephrosis. Fibrosis of the bladder with reduced capacity was the usual clinical outcome. A systemic effect was tubular necrosis with anuria, with two deaths. Another complication was ureteric obstruction, which was not related to ureteric fibrosis or bladder wall fibrosis obstructing the intramural ureter in two cases the obstruction appeared to be due to retroperitoneal fibrosis (SEDA-11, 476) (4). 

Refluxing ureters can be treated endoscopically with sub-ureteric injection of polytetrafluoroethylene paste (Polytef), the STING procedure. However, ureteric obstruction has been described as a complication (8). Urinary incontinence has also been treated by periurethral or submucosal injections of Polytef, but reports of urinary obstruction (9,10) and poor long-term success (11,12) have limited the range of indications for this treatment. Other reported complications of Teflon injection for stress urinary incontinence include periurethral abscess, urethral diverticulum. Teflon granuloma with urethral wall prolapse (13), and microembolization (14). 

Crew JP, Donat R, Roskell D, Fellows GJ. Bilateral ureteric obstruction secondary to the prolonged use of tiaprofenic acid. Br J Clin Pract 1997 51(l) 59-60. 

In the kidney, clusterin is a component of immune deposits and its expression is increased after ischemia or obstruction. In gentamicin-treated rats, an increase in urinary clusterin protein may provide an early sign of nephrotoxicity [336]. In rats with unilatertral ureteral obstruction, clusterin mRNA and clusterin-beta have been detected in the kidney along with clusterin-alpha in the urine [337]. A central role for glomerular clusterin as a modulator of inflammation that potentially influences the chnical outcome in human membranous glomerulonephritis has been described [338]. 

Ishii A, Sakai Y, Nakamura A. Molecular pathological evaluation of clusterin in a rat model of unilateral ureteral obstruction as a possible biomarker of nephrotoxicity. Toxicol Pathol. 2007 35 376-82. 

Park KM, Kramers C,Vayssier-Taussat M, Chen A, Bonventre JV. Prevention of Kidney Ischemia/Reperfusion-induced functional Injury, MAPK and MAPK Kinase Activation, and Inflammation by Remote Transient Ureteral Obstruction. J BiolChem, 2002 277 ... 

The clinical circumstances that lead to chronic "analgesic abuse" nephropathy [111] are quite distinct to the rare occurrence of acute papillary necrosis associated with exposure of fhe patient to a single NSAID and often with only a short period of drug exposure. In these acute circumstances, the patient will typically present clinically with gross hematuria and may have flank pain suggestive of ureteric obstruction consequent to the passage of a sloughed papilla. 

Two mechanisms responsible for phenylbutazone-induced acute oligo-anuric renal failure include 1) inhibition of uric acid reabsorption, leading to hyperu-ricosuria and, ultimately, bilateral ureteral obstruction due to uric acid stones [112] 2) an idiosyncratic reaction has been reported that results in acute tubular injury without uric acid precipitation [113]. 

Haas JA, Osswald H. Adenosine Induced fall in glomerular capillary pressure effect of ureteral obstruction and aortic constriction in the Munich-Wistar rat kidney. Naunyn Schmiedebergs Arch Pharmacol 1981 317 86-89. 

Transient increase in bone pain transient increase in tumour mass, resulting in ureteral obstruction and/or spinal cord compression in patients with metastatic prostate cancer hot flashes... 

Abnormal bimanual examination Possible bilateral ureteral obstruction or cervical cancer Postobstruction renal failure... 

Drug therapy may also cause renal insufficiency due to lower urinary tract obstruction. Ureteral obstruction can be caused by calculi or retroperitoneal fibrosis. Bladder dysfunction with urinary outflow obstruction can result, particularly in males with prostatic hypertrophy, from anticholinergic drugs including tricyclic antidepressants and disopyramide. Bladder outlet and ureteral obstruction may result from bladder fibrosis following hemorrhagic cystitis with cyclophosphamide or ifosfamide therapy. Concurrent treatment with mesna can prevent cystitis and this complication. 

Di Pelvic lymph nodes or ureteral obstruction D2 Bone, distant lymph node, organ, or soft tissue metastases... 

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