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Hydronephrosis - Intro
 

Hydronephrosis - Intro

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  • Def. from Campbell- walsh urologyAbsence of obstruction – when renal pelvis is congenitally capacious vesico-ureteral reflex
  • Bilateral fetal hydronephrosis
  • Intermittent HN: obstruction occurs, swelling and pain appear in the loin. After sometime patient passes large amount of urine following which swelling and pain disappear – Dietl’s crisisPersistent HN: It is due to persistent partial obstruction.

Hydronephrosis - Intro Hydronephrosis - Intro Presentation Transcript

  • Hydronephrosis Amarendra B. Singh 090201263
  • Definition • Hydronephrosis is the aseptic dilatation of the renal pelvis or calyces. • It may be associated with obstruction but may be present in the absence of obstruction. • There is accompanied destruction of kidney parenchyma. 8/18/2013 Hydronephrosis - Intro 2
  • 8/18/2013 Hydronephrosis - Intro 3
  • Etiology • It can be Unilateral or bilateral. • Unilateral maybe extramural, intramural or Intraluminal • Bilateral causes are either congenital or acquired 8/18/2013 Hydronephrosis - Intro 4
  • Unilateral hydronephrosis • By some form of ureteric obstruction, with the ureter above the obstruction being dilated. Causes A. Extramural obstruction B. Intramural (in the walls) C. Intraluminal 8/18/2013 Hydronephrosis - Intro 5
  • Causes of Unilateral hydronephrosis A. Extramural 1. Obstruction by Aberrant renal vessels (vein or artery). It is common on left side. 2. Compression by growth ( CA cervix, carcinoma rectum) 3. Retroperitoneal fibrosis (Ormond disease) 4. Retrocaval ureter 8/18/2013 Hydronephrosis - Intro 6
  • B. Intramural 1. Congenital PUJ obstruction 2. Ureterocele 3. Neoplasm of ureter 4. Narrow ureteric orifice 5. Stricture ureter following removal of stone, pelvic surgeries or tuberculosis of ureter. 8/18/2013 Hydronephrosis - Intro 7
  • C. Intraluminal 1. Stone in the renal pelvis 2. Sloughed papilla in papillary necrosis 8/18/2013 Hydronephrosis - Intro 8
  • Bilateral Hydronephrosis • Result of urethral obstruction ; but may also be caused by one of the lesions described above occurring on both sides 8/18/2013 Hydronephrosis - Intro 9
  • Causes of Bilateral hydronephrosis A. Congenital • Congenital stricture of external urethral meatus, pin-hole meatus. • Congenital posterior urethral valve. B. Acquired • BPH • Carcinoma prostate • Postoperative bladder neck scarring • Inflammatory / traumatic urethral stricture • Phimosis • Carcinoma cervix • Bladder carcinoma 8/18/2013 Hydronephrosis - Intro 10
  • Classification • Classification I —Unilateral HN —Bilateral HN without renal failure —Bilateral HN with renal failure • Classification II – Intermittent HN – Persistent HN • Classification III – HN only – HN with hydroureter • Classification IV – Extrarenal pelvic HN (80%) – Intrarenal pelvic HN (20%)8/18/2013 Hydronephrosis - Intro 11