• HYDRONEPHROSIS

  • Hydronephrosis is an aseptic dilatation of pelvicalyceal system due to partial or intermittent obstruction to the outflow of urine.

   

  ETIOLOGY-

  I) Unilateral

  1. Intraluminal (in the lumen)

  a) Stone in the renal pelvis or ureter

  b) Slough papilla in papillary necrosis

       2. Intramural (in the wall)

a) Congenital pelviureteric junction obstruction(PUJ)

b) Ureterocele

c) Neoplasm of ureter

d) Narrow ureteric orifice

e) Ca of ureter or carcinoma of bladder

f) Stricture of ureter secondary to stone

g) TB of ureter and bladder

       3. Extramural-

a) Involvement of ureter by carcinoma cervix, rectum, bladder.

b) Obstruction by aberrant vessels

c) Retrocaval ureter

d) Horse shoe kidney

 

II) Bilateral hydronephrosis-

a) Congenital

i) Congenital stricture of external urethral meatus, pinhole meatus

ii) Congenital posterior urethral valve

b)      Acquired

i) BPH

ii) Calcium prostate

iii) Postoperative bladder neck scarring

iv) Inflammatory urethral stricture

v) Phismosis

vi) Carcinoma cervix

vii) Pregnancy

     PATHOLOGY-

• There is calyceal dilatation and renal parenchyma is destroyed by pressure atrophy
• Urethral obstruction à detrusor hypertrophy à obstruction of ureter in intramural course

 

    CLINICAL FEATURES-

1. Unilateral hydronephrosis

• More seen in women
• Right side kidney is affected more commonly
• Dull aching loin pain with dragging sensation
• Painless enlargement of kidney
• Attack of acute renal colic
• Dietel’s crisis (intermittent hydronephrosis)-

     – In unilateral hydronephrosis, a swelling in the loin is associated with acute renal pain.

     – Later, pain is relieved and swelling disappear with passage of urine.

 

     2. Bilateral hydronephrosis-

     –  From lower urinary obstruction, symptoms of bladder outflow obstruction predominate.

     – From upper urinary tract obstruction, loin pain, mass in the loin, attack of renal colic.

 

INVESTIGATIONS-

1. USG- IOC

• Diagnosis for PUJ obstruction in utero.
• Enlarged kidneys

     2. Excretion urography-

• Function in the obstructed kidney

     3. Isotope renography (DTPA scan)

• Tc 99m
• It is the best test shows dilatation of the renal collecting system is caused by obstruction

    4. Whitaker test

 

TREATMENT-

1. Surgery- for bouts of renal pain, increase hydronephrosis, parenchymal damage and infection
2. Conservation of renal tissue is the aim
3. Mild cases followed by USG and operated upon if dilation is increased.
4. Pyeloplasty

• Anderson- hynes operation
• V- Y pyeloplasty

 

ABERRANT RENAL VESSELS-

• • In the lower pole of kidney can compress the PUJ causing hydronephrosis
  • Can be treated with ligation

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