Chronic unilateral obstructive uropathy

Alternative names

Unilateral chronic obstructive uropathy; Chronic ureteral obstruction

Definition

According to best urologist in Janakpuri, it is a condition in which there is a prolonged blockage of one of the ducts (ureters) that drains urine from the kidneys.

Unilateral obstructive uropathy usually occurs when kidney or ureteral stones block the flow of urine. The urine is dammed and causes a swelling of the kidney (hydronephrosis).

Among the risks of suffering from unilateral obstructive uropathy are:

• Kidney stones
• Tumours in surrounding structures such as the uterus, cervix, or lymph nodes
• Ureteral stones and tumours

According to urologist in Janakpuri, Chronic unilateral obstructive uropathy occurs in approximately 5 out of every 1000 people.

Symptoms

• Abdominal pain in the lower right or left ventral area
• Back pain that can occur on one side only
• Blood in the urine
• Urgent need to urinate
• Frequent need to urinate at night
• Painful urination
• Side pain that can occur on only one side, but can also be felt in the groin, genitals or thigh
• Urinary infection

Signs and tests

The urologist in West Delhi will perform a physical examination, which includes palpation of the abdomen. The test may reveal a swollen kidney.
A measurement of blood pressure may reveal high blood pressure. A urinalysis can show blood in the urine and a urine culture can determine if the person has an infection.
Kidney swelling or obstruction of the ureter may appear in these tests:

• Abdominal ultrasound
• Intravenous pyelogram (IVP)
• Abdominal or renal CT

Treatment

The goal of treatment is to reduce or eliminate the obstruction.

The stents or drains placed in the ureter or renal pelvis may provide relief of symptoms in the short term.

A nephrostomy tube, which drains urine from the kidney through the back, may be used to relieve the obstruction.

Surgery at kidney hospital in Palam to repair the cause of the blockage usually corrects the problem.

Expectations (prognosis)

This condition causes damage to the urinary tract and can cause permanent damage to the kidneys. If only one kidney is involved, the other kidney usually continues to function and there is no failure or kidney failure.

Complications

• Chronic or recurrent urinary infection
• Arterial hypertension
• Permanent failure of the affected kidney (chronic renal failure)

Situations that require medical assistance

The person should consult with the best urologist in West Delhi if they have pain in the flank or other symptom of chronic unilateral obstructive uropathy.

If this condition has already been diagnosed by urologist in Palam, it should be consulted if the symptoms worsen or persist despite treatment or if new symptoms develop.

Prevention

If the person is prone to kidney stones, he should drink plenty of water (6 to 8 glasses a day) to reduce the likelihood of kidney stones forming.

A diet low in sodium and oxalate, and high in citrate can reduce the risk of developing kidney stones based on calcium, so it is recommended to consult a nutritionist to obtain more information about these diets.

UTIs should be treated promptly and thoroughly at Kidney hospital in West Delhi.

Treatment of chronic testicular pain

Treatment of chronic testicular pain

As a best urologist in Palam, West Delhi, I have decided to write this post after having treated in my practice, in recent weeks, several patients who had this problem and had long been going around trying to solve without success. In general, the patients I see in the kidney hospital in Palam, West Delhi have been evaluated by a multitude of specialists, they have undergone all kinds of tests, they have undergone multiple treatments ... without solving chronic pain.

The first thing we should do with a patient who is consulting for chronic testicular pain is a good clinical history in which we value:

• Analysis of pain and its circumstances: from when you have it; possible causes (previous surgeries in the linguino-scrotal, abdominal or retroperitoneal area, traumatisms, infections or inflammations in these areas, etc.); characteristics and intensity of pain; irradiation thereof; triggering factors (when sitting, when urinating, when having an erection, when making a bowel movement, when the testicle is palpated, etc.); associated symptomatology (urinary frequency, urgency, nocturia, rectal or urinary tenesmus); etc.
• Physical examination:  of the testicle, epididymis, deferent, spermatic cord, inguinal canal (hernias), abdomen, fist, renal percussion, etc.
• Essential tests:  fractionated urine and semen culture, testicular eco-Doppler, abdominal and urological ultrasound. In some cases, it may be useful to perform Magnetic Nuclear Resonance of the pelvis.

With respect to treatment, our approach is as follows:

• First, treatment of any process that could have caused the pain: torsion of testicular appendix, varicocele, epididymitis, orchitis, inguinal hernia, testicular tumour, tension hydrocele, etc. One should not lose sight of the so-called referred pain, that is, when the pain is caused by problems in other abdominal viscera but the patient locates it in the testicle (for example, kidney or ureter stones, appendicitis, etc.).
• Second, use of analgesics. We use Paracetamol, Tramadol or the combination of both, depending on the intensity of the pain. In some cases, it is necessary to resort to specific treatments for what we call neuropathic pain (pain caused by disease or direct problem of the somatosensory nervous system). Among these neuropathic pain treatments, we have: carbamazepine, gabapentin, pregabalin, tricyclic antidepressants, etc.
• In many patients, especially if the pain is of moderate or severe intensity, very constant, long evolution, etc. it is advisable to resort to psychological or psychiatric support to avoid anxiety, depression, stress, etc. associated with this situation.
• If the pain does not remit with medication, we can resort to infiltration of the spermatic cord with anaesthetics and corticosteroids; radiofrequency; etc.

But in a high percentage of cases (possibly in more than 50% of patients) none of the above solves the problem. In these patients the only solution is surgery of denervation of the testicle. This is a technique that consists in sectioning all the nervous branches that collect the sensitivity of the testicle, thus avoiding the transmission of the painful sensation to the central nervous system. As a preliminary step, we should perform a cord block with local anaesthetics to confirm the possible efficacy of the subsequent surgical intervention. If the aesthetic block is effective, we will have a guarantee that the surgery will solve the pain. The surgical procedure must be performed by the best urologist in Janakpuri, West Delhi with the help of a surgical microscope that allows us to identify the arteries (testicular and deference); the veins; the lymphatics and the vas deferens, which will be the only structures that will be respected.