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Management of Upper Urinary Tract Obstruction: Difference between revisions

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=== Diagnosis and Evaluation ===
=== Diagnosis and Evaluation ===


==== '''History and Physical Exam''' ====
==== History and Physical Exam ====


*'''History'''
*'''History'''
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**# '''<span style="color:#ff0000">Uncommonly, abdominal mass, or hematuria secondary to infection'''
**# '''<span style="color:#ff0000">Uncommonly, abdominal mass, or hematuria secondary to infection'''


==== '''Imaging''' ====
==== Imaging ====
* Performed to determine the anatomic site and functional significance of an apparent obstruction
* Performed to determine the anatomic site and functional significance of an apparent obstruction
* '''Diuretic renography'''
* '''Diuretic renography'''
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***'''<span style="color:#ff0000">The Foley catheter is usually removed 24 to 36 hours postoperatively, and the surgical drain is removed before hospital discharge if the drain output remains negligible.</span>'''
***'''<span style="color:#ff0000">The Foley catheter is usually removed 24 to 36 hours postoperatively, and the surgical drain is removed before hospital discharge if the drain output remains negligible.</span>'''
**** '''<span style="color:#ff0000">If the drain output increases after the Foley catheter removal, the Foley catheter should be replaced for 7 days to eliminate urinary reflux along the stent in the treated ureter and decrease urinary extravasation at the ureteropelvic anastomosis.</span>'''
**** '''<span style="color:#ff0000">If the drain output increases after the Foley catheter removal, the Foley catheter should be replaced for 7 days to eliminate urinary reflux along the stent in the treated ureter and decrease urinary extravasation at the ureteropelvic anastomosis.</span>'''
*** '''<span style="color:#ff0000">The ureteral stent is typically removed 4-6 weeks later in an outpatient setting, and follow-up including the use of imaging studies such as diuretic renal scan is performed</span>'''
*** '''<span style="color:#ff0000">Ureteral stent is typically removed 4-6 weeks later in an outpatient setting</span>'''
***'''<span style="color:#ff0000">Follow-up including the use of imaging studies such as diuretic renal scan is performed</span>'''
** '''Complications'''
** '''Complications'''
***'''Late'''
***'''Late'''
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**** '''Recurrent obstruction'''
**** '''Recurrent obstruction'''
*****'''Most failures from laparoscopic pyeloplasty occur in the first 2 years.'''
*****'''Most failures from laparoscopic pyeloplasty occur in the first 2 years.'''
***** '''<span style="color:#ff0000">For patients who fail laparoscopic pyeloplasty, open surgery has been used as a salvage procedure. However, most patients can be well managed with endoscopic intervention</span>'''
***** '''<span style="color:#ff0000">Management</span>'''
******'''<span style="color:#ff0000">Options (2)</span>'''
*******'''<span style="color:#ff0000">Repeat pyeloplasty (open surgery has been used as a salvage procedure after failed laparoscopic pyelopasty)</span>'''
*******'''<span style="color:#ff0000">Endoscopic intervention (most patients can be managed</span>'''  


==== Ureterocalicostomy ====
==== Ureterocalicostomy ====
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