Thursday, January 9, 2014

Consult Rounds: Non Dilated Obstructive Uropathy

Dilatation of the calyces, renal pelvis and ureters is classically what we observe in sonography to make the diagnosis if obstruction. In some cases, a phenomenon of non dilated obstruction does happen where no signs of obstruction can be noted in US or CT scans. 

One of the earlier studies had looked at a series of patients at a single center and found that most common cause of these type of situations were cancers ( likely RP related)- so prostate, colon, bladder, lymphomas and other series have found cervical cancer as well.  Antegrade urography had found the obstruction in all of the cases in that one series. 

Why does it happen?- RP fibrosis can perhaps interfere with peristalsis and lead to non dilatation, RP carcinamatosis can encase the ureters and renal pelvis producing obstruction without dilatation or could this be a chronic incomplete obstruction are some suggestions based on the authors.

Treatment is usually diagnostic.  Given the pathology and the cause of the obstruction being present after an ureteral stents are placed, they usually only temporize the treatment. Percutaneous nephrostomy is usually the best procedure in such situations. 

Here are some other studies regarding this interesting entity.

1 comment:

  1. This scenario is common in advanced carcinoma cervix who are on palliative treatment.

    Careful history (absence of setting for severe ATN to explain anuria) and physical examination (ortho stasis and other signs of dehydration) can provide clue to this diagnosis.

    Ureteric catheterisation (you should be lucky to have a good urology friend) is diagnostic and therapeutic.


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