Urinary Tract Obstruction – This course is designed to understand the concept of community health nursing: nurses’ roles and interventions in family health, school health, occupational health, environmental health, elderly health care, gender issues, disaster management and principles and terminology of epidemiology. The aim of the course is to acquire knowledge and skills in community health nursing.
Urinary Tract Obstruction
Definition of Urinary Tract Obstruction:
Urinary tract obstruction is a blockage that inhibits the flow of urine through its normal path (the urinary “tract), including the kidneys, ureters, bladder, and urethra.
Example: Urolithiasis, Prostatic enlargement, shrink of the urinary tract, distortion of urinary tract.
Or
‘An obstruction in the urinary tract may occur at any point between the renal tubules and the unilateral or
mmon Causes of Urinary Tract Obstruction:
Blockage may be partial or complete, affect one side or both sides, and develop rapidly (acutely) or slowly (chronically). The most common causes overall are
➤In children: Structural abnormalities-for example, birth defects such as valves in the inside back part of the urethra (called posterior urethral valves) and other constrictions that narrow or block the ureter or urethra
➤In young adults: Stones in a kidney or ureter or elsewhere in the urinary tract
➤ In older adults: Benign prostatic hyperplasia (BPH) or prostate cancer, tumors, and stones
➤The many other possible causes of urinary tract obstruction include the following:
- Polyps in the ureter
- Blood clot in the ureter
- Tumors in or near the ureter
- Formation of fibrous (scar) tissue in or around the ureter resulting from surgery, radiation therapy, or drugs (especially methysergide)
- Bulging of the lower end of the ureter into the bladder (ureterocele)
- Tumor, abscesses, and cysts of the bladder, cervix, uterus, prostate, or other pelvic organs
- A large mass of feces stuck in the rectum (rectal impaction)
Post-Operative Complication of Urinary Tract Obstruction
General postoperative complications:
Immediate
- Primary haemorrhage (starting during surgery) or reactionary haemorrhage (following postoperative increase in blood pressure) – replace blood loss and may require return to theatre to re-explore the wound.
- Basal atelectasis: minor lung collapse.
- Shock: blood loss, acute myocardial infarction, pulmonary embolism or septicaemia.
- Low urine output: inadequate fluid replacement intra-operatively and postoperatively.
Early
- Pain.
- Acute confusion: exclude dehydration and sepsis. May also be due to other various causes, including pain, sleep disturbance, metlication or metabolic disturbances.
- Nausea and vomiting: analgesia or anaesthetic-related; paralytic ileus.
- Fever (see ‘Postoperative fever’, below).
- Secondary haemorrhage: often as a result of infection.
- Pneumonia.
- Wound or anastomosis dehiscence.
- DVT.
- Acute urinary retention.
- Urinary tract infection (UTI).
- Postoperative wound infection.
- Pressure sores.
- Bowel obstruction due to fibrinous adhesions.
- Paralytic Ileus.
Late
- Nursing care of adult clients with disorder in genitourinary system
- Bowel obstruction due to fibrous adhesions.
- Incisional hernia.
- Persistent sinus.
- Recurrence of reason for surgery – eg, malignancy.
- Keloid formation.
- Cosmetic appearance depends on many factors (best discussed with surgeon).
Complications of untreated urinary tract obstruction include:
- Infection (cystitis, pyelonephritis, abscess formation and sepsis).
- Urinary extravasation.
- Fistula formation.
- Renal insufficiency or failure.
- Bladder dysfunction.
- Pain.
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