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Urology 4: Hydronephrosis

Urology 4: Hydronephrosis. Contents. Definition Etiology Pathology Clinical features Special investigations Treatment. 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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Urology 4: Hydronephrosis

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  1. Urology 4: Hydronephrosis

  2. Contents • Definition • Etiology • Pathology • Clinical features • Special investigations • Treatment

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

  4. Hydronephrosis

  5. Normal kidney Hydronephrosis

  6. Normal Intravenous Pyelogram (IVP)

  7. Intravenous Pyelogram (IVP)Showing Hydronephrosis

  8. Etiology • Primary or secondary • Primary: idiopathic • Secondary: maybe unilateral or bilateral

  9. 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

  10. Causes of unilateral hydornephrosis • Maybe extramural, intramural or Intraluminal • Intramural: • Congenital stenosis or achalasia of the PUJ • Ureterocele • Stricture • Neoplasm of ureter

  11. Causes of unilateral hydornephrosis • Maybe extramural, intramural or Intraluminal • Intraluminal: • Calculus • Congenital folds at the upper end of the ureter

  12. 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

  13. Causes of bilateral hydornephrosis • Due to pathologies in the urethra or the urinary bladder • Causes in the bladder: • Calculus • Neoplasms • Sphincter dysfunction

  14. 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

  15. 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

  16. Clinical features • May depend on unilateral, intermittent or bilateral hydronephrosis • Intermittent hydronephrosis: • Dietl’s crisis

  17. Clinical features • May depend on unilateral, intermittent or bilateral hydronephrosis • Bilateral hydronephrosis: • Features of the causes • Bilateral renal swelling

  18. Special investigations • Straight abdomen of the X- ray • Excretory urography • Retrograde urography • Ultrasound

  19. Treatment • Secondary hydronephrosis: treatment of the cause • Primary hydronephrosis: • Pyeloplasty: • Anderson- Hynes • Culp • Foley • Nephrectomy

  20. 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

  21. extraperitoneal flank approach, bed of the twelfth rib

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