Urology%204:%20Hydronephrosis

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Urology 4 Hydronephrosis
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Contents

• Definition
• Etiology
• Pathology
• Clinical features
• Special investigations
• Treatment

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Definition

• Dilatation of renal pelvis calyces with
  accompanying destruction of the kidney parenchyma
• Usually due to partial obstruction to the outflow
  of urine

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Hydronephrosis
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Normal kidney
Hydronephrosis
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Normal Intravenous Pyelogram (IVP)
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Intravenous Pyelogram (IVP) Showing
Hydronephrosis
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Etiology

• Primary or secondary
• Primary idiopathic
• Secondary maybe unilateral or bilateral

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Causes of unilateral hydornephrosis

• Maybe extramural, intramural or Intraluminal
• Extramural
• Pressure on the ureter by loaded sigmoid colon,
  gravid uterus, uterine ovarian tumors
• Involvement of the ureter by malignant neoplasm
  outside it e.g. carcinoma of the cervix, uterus,
  colon, rectum, prostate
• Aberrant renal vessels
• Idiopathic retroperitoneal fibrosis

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Causes of unilateral hydornephrosis

• Maybe extramural, intramural or Intraluminal
• Intramural
• Congenital stenosis or achalasia of the PUJ
• Ureterocele
• Stricture
• Neoplasm of ureter

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Causes of unilateral hydornephrosis

• Maybe extramural, intramural or Intraluminal
• Intraluminal
• Calculus
• Congenital folds at the upper end of the ureter

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Causes of bilateral hydornephrosis

• Due to pathologies in the urethra or the urinary
  bladder
• Causes in the urethra
• Pin hole meatus
• Congenital valves
• BPH carcinoma of prostate
• Stricture
• Carcinoma of cervix uterus

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Causes of bilateral hydornephrosis

• Due to pathologies in the urethra or the urinary
  bladder
• Causes in the bladder
• Calculus
• Neoplasms
• Sphincter dysfunction

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Pathophysiology

• Dilatation of the renal pelvis calyces
• Types of hydronephrosis
• Pelvic type
• Renal type
• Pelvirenal type most common type, both the
  pelvis calyces are equally dilated

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Clinical features

• May depend on unilateral, intermittent or
  bilateral hydronephrosis
• Unilateral hydronephrosis
• Dull ache sense of weight on the affected side
  of the loin
• Causes of the hydronephrosis

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Clinical features

• May depend on unilateral, intermittent or
  bilateral hydronephrosis
• Intermittent hydronephrosis
• Dietls crisis

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Clinical features

• May depend on unilateral, intermittent or
  bilateral hydronephrosis
• Bilateral hydronephrosis
• Features of the causes
• Bilateral renal swelling

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Special investigations

• Straight abdomen of the X- ray
• Excretory urography
• Retrograde urography
• Ultrasound

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Treatment

• Secondary hydronephrosis treatment of the cause
• Primary hydronephrosis
• Pyeloplasty
• Anderson- Hynes
• Culp
• Foley
• Nephrectomy

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Principles of pyeloplasty

• To reduce the size of the renal pelvis
• Excision of the PUJ
• The ureter is attached to the most dependent part
  of the pelvis

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extraperitoneal flank approach, bed of the
twelfth rib
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