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Uropatia obstrutiva

Última revisão: 14 Aug 2025
Última atualização: 13 Sep 2024

Resumo

定义

病史和体格检查

关键诊断因素

  • sinais de disfunção orgânica precoce (taquipneia, taquicardia, hipotensão, estado mental alterado) em um paciente com suspeita de sepse
  • dor no flanco
  • febre
  • sintomas do trato urinário inferior
  • abdome distendido/bexiga palpável
  • incapacidade de urinar
  • próstata aumentada ou nodular com consistência dura no exame retal
  • sensibilidade no ângulo costovertebral
  • doença neurológica (por exemplo, lesão da medula espinhal, esclerose múltipla)
完整详情

其他诊断因素

  • hematúria
  • idade mais avançada
  • estreitamento meatal
  • malignidade abdominal ou pélvica
  • intervenção uretral prévia
  • infecção do trato urinário em uma criança
  • massa pélvica no exame físico interno
  • perda de peso e linfadenopatia
  • infecção do trato urinário recorrente
  • incontinência urinária
完整详情

危险因素

  • hiperplasia prostática benigna (HPB)
  • constipação
  • medicamentos (agentes anticolinérgicos, analgésicos opioides, agonistas do receptor alfa)
  • urolitíase (cálculos ureterais)
  • lesão da medula espinhal, doença de Parkinson ou esclerose múltipla
  • neoplasia maligna
  • gestação
  • hematúria
  • valvas uretrais posteriores
  • hérnia vesical
  • cistocele
  • lesão iatrogênica
  • intervenção uretral
  • fibrose retroperitoneal
  • estenose meatal
完整详情

诊断性检查

首要检查

  • tira reagente para exame de urina
  • ultrassonografia renal
  • ureia e creatinina
  • Hemograma completo
  • TC de abdome e pelve sem contraste
完整详情

需考虑的检查

  • urocultura
  • hemocultura
  • TC de abdome e pelve, com e sem contraste
  • urografia por ressonância magnética (URM)
  • pielograma intravenoso (urografia excretora)
  • renografia nuclear (cintilografia renal tripla/MAG3)
  • cistouretrografia miccional
  • ultrassonografia da bexiga
  • antígeno prostático específico
  • marcadores tumorais (por exemplo, antígeno carcinoembriogênico [CEA] sérico, CA125)
完整详情

治疗流程

初步治疗

obstrução unilateral ou bilateral com sinais de infecção

急症处理

obstrução uni ou bilateral decorrente de cálculos sem sinais de infecção

obstrução unilateral não decorrente de cálculos, sem sinais de infecção

obstrução bilateral não decorrente de cálculos, sem sinais de infecção

撰稿人

作者

Harris E. Foster Jr., MD

Professor of Urology

Section Chief of Lower Urinary Tract Dysfunction and Reconstruction

Yale School of Medicine

New Haven

CT

利益声明

HEF declares that he has no competing interests.

Adam Benjamin Hittelman, MD, PhD

Associate Professor in Urology

Section Chief of Pediatric Urology

Yale School of Medicine

New Haven

CT

利益声明

ABH declares that he has provided expert testimony and has given lectures on obstructive uropathy.

Parth M. Patel, MD

Assistant Professor of Urology

Department of Urology

University of California Los Angeles

Los Angeles

CA

利益声明

PMP declares that he has no competing interests.

鸣谢

Harris E. Foster Jr., Adam Benjamin Hittelman, and Parth M. Patel would like to gratefully acknowledge Adrienne J. Carmack, a previous contributor to this topic.

利益声明

AJC declares that she has no competing interests.

同行评议者

Brian Cohen, MD

Private Practice Urologist

Asheville

NC

利益声明

BC declares that he has no competing interests.

Yekutiel Sandman, MD

Private Practice Urologist

Miami

FL

利益声明

YS declares that he has no competing interests.

Vincent Gnanapragasam, MBBS, BMedSci, PhD, FRCSEng, FRCSEd(Urol)

Lecturer in Uro-oncology and Consultant Urological Surgeon

Department of Urology

Addenbrooke's Hospital

Cambridge

UK

利益声明

VG declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Wessells H, Morey A, Souter L, et al. Urethral stricture disease guideline amendment (2023). J Urol. 2023 Jul;210(1):64-71.全文  摘要

American College of Radiology. ACR appropriateness criteria: acute onset flank pain-suspicion of stone disease (urolithiasis)​. 2023 [internet publication].全文

American Urological Association; Endourological Society. Surgical management of stones: AUA/Endourology Society guideline. 2016 [internet publication].全文

Sandhu JS, Bixler BR, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA guideline amendment 2023. J Urol. 2024 Jan;211(1):11-19.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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