Obstruction of the upper and lower urinary tract

In upper tract obstruction imaging is the cornerstone of investigation. The most commonly used radiological investigation being a stone protocol non-contrast computed tomography scan of kidneys, ureters and bladder (NCCT-KUB). Acute and chronic lower tract obstruction is often treated in the initial stages by the passage of a urethral catheter. Chronic lower tract obstruction can be high or low pressure. High-pressure chronic retention is potentially fatal due to renal failure and therefore monitoring of fluid status and serum electrolytes is essential. The initial treatment for obstruction is dependent on the presence or absence of renal impairment and sepsis. If either of these is present then some form of upper tract decompression may be warranted, either in the form of percutaneous nephrostomy tubes or JJ stents.