Hydronephrosis

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Hydronephrosis

• Dept. Of Urology. shanghai Renji hospital
• WANG YIXIN

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Etology of hydronephrosis

• 1.Primary hydroneprosis
• intrinsic strinsic strictrue
• high insertion of the ureter
• PUJ
• nephroptosis
• extrisic compresion
• renal pelvis stone or tumor

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Etology of hydronephrosis

• 2.Secondary hydronephrosis
• visicoureteral reflux
• obstruction distal to the ureteropelvic junction
• stone, tumor, extrinsic ureteral compression,
• myoneurogenic disease, ureterocele, CAB, ca of
  pelvic viscera
• bladder outer obstruction CAP, BPH
• urethral obstruction
• pregnancy

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Pathology of hydronephrosis

• 1.first shows evidence of hyperactivity and
  hypertrophy than dilatation and atony
• 2.muscular loss of peristaltic activity
• 3.atrophy of the renal parenchyma
• 4.compression of the arcuate vessels ischmic
  atrophy

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Symptoms and signs of hydronephrosis

• 1.asymptomatic (in some cases)
• 2.pain is felt in the renal area
• 3.hematuria
• 4.urinary infection, dysuria frequency
• 5.calculi
• 6.azotemia
• 7.unexplained vague GI symptoms
• 8.some large hydronephrosis can be palpable

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Diagnosis of hydronephrosis

• 1. symptoms and signs
• 2. ultrasound
• 3. IVU
• 4. Cystourethralgram
• 5. Cystoscopy
• 6. RGP
• 7. Delayed empty
• 8. Isotope renography
• 9.urine culture

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Treatment of hydronephrosis

• 1. U.T.I. Antibiotic therapy
• 2. Prompt drainage
• 3 corrected to the cause
• 4. Relief of lower tract obstruction
• catheter drainage ,urinary diversion ,
  indwelling pigtail ureteral catheter
• 5. Nephrectomy( tumor or nonfunction kidney)

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Prognosis of hydronephrosis

• Deponds on the cause ,site, duration , and
• degree of kidney damage .