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Hydronephrosis - Intro
Hydronephrosis is the dilatation of the renal pelvis or calyces, which can be associated with obstruction. It can be unilateral or bilateral. Unilateral causes include extramural obstruction from aberrant vessels or tumors, intramural obstruction from congenital abnormalities or strictures, and intraluminal obstruction from stones. Bilateral causes are usually congenital such as valves or acquired such as prostate enlargement. Hydronephrosis is classified based on unilateral vs bilateral involvement, intermittent vs persistent, presence of hydroureter, and location within or outside the kidney.
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Hydronephrosis - Intro
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- 2. Definition • Hydronephrosis isthe 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
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- 4. Etiology • It canbe Unilateral or bilateral. • Unilateral maybe extramural, intramural or Intraluminal • Bilateral causes are either congenital or acquired 8/18/2013 Hydronephrosis - Intro 4
- 5. Unilateral hydronephrosis • Bysome 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
- 6. Causes of Unilateralhydronephrosis 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
- 7. B. Intramural 1. CongenitalPUJ 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
- 8. C. Intraluminal 1. Stonein the renal pelvis 2. Sloughed papilla in papillary necrosis 8/18/2013 Hydronephrosis - Intro 8
- 9. Bilateral Hydronephrosis • Resultof urethral obstruction ; but may also be caused by one of the lesions described above occurring on both sides 8/18/2013 Hydronephrosis - Intro 9
- 10. Causes of Bilateralhydronephrosis 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
- 11. Classification • Classification I —UnilateralHN —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
Editor's Notes
- #3 Def. from Campbell- walsh urologyAbsence of obstruction – when renal pelvis is congenitally capacious vesico-ureteral reflex
- #10 Bilateral fetal hydronephrosis
- #12 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.