| Objective:To improve the diagnosis and treatment of acute anuria caused by upper urinary tract obstruction. Methods:The articles on acute obstructive anuria published in recent years were reviewed. 58 patients suffered from acute anuria caused by upper urinary tract obstruction were analysed on obstructive diagnosis, etiological diagnosis, the value of image diagnosis, treatment, and the judgement of recovery of renal function. Results:The causes of all cases were acute upper urinary tract obstructions. In one case injected gentamycin for long term, renal anuria was regarded firstly, but tumor compression was confirmed as the truth finally. In one patient with polycystic kidney (one kidney was already resected), bad renal function was thinked as the cause of anuria, but calculus of ureter was the true cause. In 2 cases with total cystectomy, prerenal renal failure was regarded as the cause of anuria because of the lower blood pressure during the operation, in fact, obstruction of ureter resulted in anuria. Inone case of upper urinary tract obstruction, anuria and polyuria presented alternatively.The common causes of acute obstructive anuria were calculi (27/58 ) , tumors (18/58) , stricture of ureter (4/58) and retroperitoneal fibrosis (3/58) . Among the upper urinary tract calculi, ureteral calculi was the most common (13/27) , and the nephrolithiasis accompanied ureteric stone was the next (9/27) , but the stones only lodged in renal collecting system was the least (5/27 ) . Colon cancer was the most mainly neoplasm caused obstructive anuria (8/18) , the second was tumor of female genital organ (6/18) ,and the third was tumors of urinary system. Bilateral or solitary renal obstruction were 91.4% (53/58) .Acute reflective anuria due to monolateral obstruction was considered in two patients (2/58) . In one case with calculus of ureter on one side, acute anuria was relieved by anti-spasm and analgesia. ?Ultrasonography, excretory urography , computed tomograhpy and magnetic resonance imaging were performed for diagnosis. MRU had the most value of diagnosis of upper urinary tract obstruction. Detective rate by B ultrasound was higher than X ray and CT/MRI(P<0.01), account for 87.7%.However, CT\ MRI had the special advantages in diagnosis of obstructive causes.Three methods were taken to manage the upper urinary tract obstructive anuria: general management, emergent treatment, and treatment of causes. In our study, 30 patients with bilateral or solitary kidney obstruction were relieved emergently (51.7%) . 19 patients with bilateral ureter obstruction were relieved on one side (32.8%). Ureteral catheters were placed successfully under cystoscopy in 20 patients, but 23 patients failed. 2 cases were placed with double J catheter on one side, 1 case was inserted ureteral catheter on one side, the other side was managed by PCN. 3cases failed to place the catheter, but the obstructions were relieved by movement of stone which caused by inserting catheter. 10 cases tried to draining urine by PCN, of which 9 cases were successful. Open nephrostomy on one side were performed in 5 cases. Dialysis was performed in 9 cases. Etiological treatment should take different methods according to different causes. Pyelolithotomy and ureterolithotomy were performed in 12 cases; Pyelolithotomy and plasty of pyeloureteral junction were performed in 1 case; Extracorporeal shock wave lithotripsy (ESWL) was performed in a solitary kidney; ESWL and PCN were performed in 2 case (one was unique functional kidney); Calculi passed spontaneously in one case, and stone was dissolved successfully with alkalinizing urine in 2 cases; Blood clots were cleaned by operation in 1 case; ureterovesical replant was performed in one case; Middle and distal bilateral ureter were resected and ileum substituted ureter in one case. If bilateral obstruction were treated at different time, the side of acute obstruction for shorter time (the side of light hydronephrosis and obvious symptoms), of operation to perform more easily...
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