Acute ureteric obstruction

Theory

Commonest cause is ureteric calculus. Other causes include extrinsic retroperitoneal pathology including abscess, haematoma, fibrosis, malignancy and iatrogenic (surgical injury).

Usually present with unilateral flank pain associated at times with haematuria and/or fever

Examination

Unilateral abdominal and flank tenderness.

Investigations

• FBE
• U&E
• MSU microscopy & culture
• Urinalysis
• Blood cultures (if febrile)
• Serum calcium, uric acid
• KUB plain X-ray
• Non-contrast CT urinary tract
• NOT ultrasound

Management

• IV fluids
• Analgesia
• Contact urologist

Urological Intervention

Obstructed kidney and sepsis – urgent nephrostomy or ureteric stenting.

Ureteric calculus with obstruction

• Large >5mm – ureteric stent/ESWL or ureteroscopy
• Smaller <5mm – conservative, tamsulosin. Intervene as above if ongoing pain or failure to progress.

Urinary stone analysis

‘Pyelonephritis’ is a clinical syndrome of flank pain and fever. Should never be accepted as a diagnosis without first excluding an obstructed kidney by imaging as above. Ultrasound will be normal in early obstruction and should NOT be used in place of KUB and CT

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