Urinary Tract Obstruction

Treatment
Consultation with a urologist should be obtained in patients with
urinary tract obstruction, as in hydronephrosis or urinary retention.
A patient with complete urinary tract obstruction; any type of
obstruction in a solitary kidney; obstruction with fever or infection;
or renal failure needs immediate attention by a urologist. Patients
with pain that is uncontrolled with oral medications or with
persistent nausea and vomiting that causes dehydration also need
immediate urological attention. A partial urinary tract obstruction in
the absence of infection can be initially managed with analgesics
and prophylactic antibiotics until a complete urologic evaluation is
performed and definitive management is completed.
 Lower urinary tract obstruction
Urethral catheter
A urethral catheter (size 8F-24F) is a flexible external catheter that extends
from the bladder through the urethra. A physician or nurse can place it. If
catheter placement is difficult, a urologist may be needed to avoid urethral
trauma. Retrograde urethrography needs to be performed to rule out
urethral injury.

Suprapubic tube or catheter

If a Foley catheter cannot be passed, a suprapubic tube can be placed
percutaneously (at the bedside) or in an open fashion (in the operating
room). A suprapubic tube is placed on the lower anterior abdominal wall,
approximately 2 finger-breadths above the pubic symphysis.
 Upper urinary tract obstruction
Ureteral stent
A ureteral stent is a flexible tube that extends from
the renal pelvis to the bladder. It can be placed during
cystoscopy to relieve obstruction along any point in
the ureter. A ureteral stent generally needs to be
changed every 3 months.
Nephrostomy tube
A nephrostomy tube is a flexible tube that is placed
through the back directly into the renal pelvis. If a
ureteral stent cannot be placed cystoscopically in a
retrograde fashion, a percutaneous nephrostomy tube
can be inserted for relief of hydronephrosis. If needed,
a ureteral stent can then be passed in an antegrade
fashion through the nephrostomy tube tract.