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Hello, everyone. We are University of, of Society and welcome to this talk on constructive neuropathies. This is one of the talks created as part of the Emy Aging Series organized with our juniors. In this presentation, we will go over the main clinical findings, investigations and management of obstructive neuropathies. And we will also be covering a case based discussion. We'll start off with the keys presentation. We have a 35 year old patient who presents to the emergency department who saw an onset of severe colic pain in the right flank that radiates the groin. He also reports nausea and vomiting and he spor with chills and malaise in terms of differential diagnosis, the character and location of the pain most likely suggest narcotic which is caused by uric calculi. The patient also seems to present an infection such as bile nephritis indicated by the presence of fevers and chills. All differentials include acute appendicitis which typically presents with pain in the right iliac fossa and other acute conditions such as intestinal obstruction, which usually leads to diffuse abdominal pain. Therefore, these last two conditions are less likely to be the cause of this presentation. Let's discuss in more detail about what causes obstructive neuropathies and their associated risk factors. In general, obstructive neuropathies are caused by a blockage of the urinary tract and that can lead to hydronephrosis and kidney injury. There are many things that can cause an obstruction. For example, urinary tract calculi which tend to present in patients who are dehydrated or hypercalcemic be prostatic hyperplasia, which is common in all the men. Other causes include recurrent UTIs, which can lead to scar tissue formation and blockage of the tract as well as malignancy. Given the white winter radiolog, we can have different presentations for obstructive neuropathies. Broadly, we can divide presentations into acute and chronic. As we've seen in our patient's case. Acute presentations can involve severe flank pain, signs of uti such as dysuria and hematuria or acute kidney injury. On the other hand, chronic presentations are likely caused by meniphos hyperplasia in men. And the symptoms can include poor flow in up with emptying of the bladder and dribbling. Longstanding chronic obstruction can also lead to chronic kidney disease. As with any other condition diagnosed with obstructive neuropathies is based on history and examination findings as well as on results from different investigations. These investigations include urinalysis which can show hematuria in the case of, you know, stones or the presence of nitrates and leucocytes for uti blood tests such as urea and creatinine can indict no injury and imaging, particularly non contrast ct kidney uterus and bladder or CT Kub is important for renal stones. With ultrasound being alternative for pregnant women and Children. The age of presentation can also help point towards diagnosis. For example, in infancy, you may suspect a congenital cause. Whereas adults are more likely to present with urary coli in older males with benign prostatic hyperplasia. The management of obstructive neuropathies will develop presenting signs and symptoms of the patient and a course of obstruction. As we can see in this background. The key point to remember is that if a patient presents with mastotic kidney with signs of infection, urgent decompression is required to prevent renal damage. Antibiotics should also be provided if there are no signs of infection. The treatment depends on the cause of the obstruction. For example, kidney stones can be removed to a tripsy. A uric stent can be put in for strictures or malignancy and benign hyperplasia can be managed with medication or catheterization. The next few slides will go a bit further into the management of strep neuropathies. Firstly, if we mentioned an obstetric kidney or sign of infection, it requires urgent decompression to prevent serious complications such as infected hydronephrosis, adrenal damage. According to the European Association of Urology guidelines, this can be achieved through placement of either a nephrostomy tube or a ureteral stent. The decision for the type of procedure performed is usually made based on discussion with urology and interventional radiology specialists and may depend on local expertise and guidelines. Nephrostomy and uretic stenting are two procedures that can be performed by interventional radiologists. These diagrams show what they involve. Firstly, a nephrostomy is a procedure where a catheter is placed in the renal cats to the skin to allow drainage of the urine into a nephrostomy bag. Locate the offset of the body on your right hand. A uric stent allows you to bypass the obstruction and drain directly into the bladder. They would either by a nephrostomy or using a cystoscope because ureter extending does not require a drainage bag. It may be the preferred procedure for chronic obstruction, such as strictures or malignancy. Nephro may be preferred in the kit presentations where the cost obstruction can be addressed later on such as the case of renal stones. In terms of the management of renal cataract with no signs of infection, usually small stones under five millimeters can pass without any intervention. So the patient can be managed conservatively with analgesia and hydration, larger stones. But under 10 millimeters can be managed medically with alpha blockers which relax the ureter promoting clearance of the stones. However, if the stone is above 10 millimeters, the nice skylines active stone removal without a Trys or PCNL in benign to study her plasia. The first line human option is medications such as alpha blockers or five alpha inhibitors. Surgical management is recommended if the patient presents with severe symptoms or if medical therapies have failed. However, surgery can have significant complications such as infection incontinence or sexual dysfunction. An alternative to surgery is an eye procedure called prostate artery embolization. This procedure cuts off the blood supp part of the prostate causing it to shrink and offers additional benefits over surgery such as complications and avoiding general anesthesia. Now, if you continue the case study from the beginning of this presentation, we have a patient presenting who had an ulcer of severe right F pain that radiates the groin. They have clinical signs of infection and decrease urine output. Examination reveals dullness to precaution of a renal area. An investigation findings show hematuria and proneural lysis, elevated crp raise blood creatinine and urea indicating a declining renal function. A CK can reduce obstructional levels of the ureter. A uteral stone causing dilation proximally and hydronephrosis. Therefore, the diagnosis in this patient is a coal signs of infection. They are managed with broad spectrum antibiotics to treat infection and the nephrostomy to decompress the kidney. This is an important presentation because infected hydronephrosis can lead to pyonephritis and subsequent urosepsis. In summary, in this presentation today, we covered key m topics including urinary tract, calculi, hyperplasia and urinary tract infections which are important presentations for obtrusive neuropathies. The main learning points relating to this topic are the following the clinical signs and symptoms as well as the risk factors depend on the etiology of obstruction. The diagnosis is primarily based on clinical findings, urinalysis and imaging. The management varies depending on the presence of infection and the cause of obstruction. It's important to remember that urgent decompression with either nephrostomy or tic stenting is required in a case of obstructive neuropathies with signs of infection. Thank you very much for your attention.
