This presentation is about hydronephrosis.

1. WELCOME

2. HYDRONEPHROSIS
BRIG GEN M.A. RAKIB
FRCS (Glasg), FCPS(Uro), FCPS(Surgery), FACS(USA), MCPS, MBBS(DMC)
ADVISOR SPECIALIST
DEPARTMENT OF UROLOGY
CMH DHAKA

3. Definition
• Hydronephrosis is defined as aseptic dilatation
of the whole or a part of the pelvi-calyceal
system of the kidney due to partial or
intermittent interruption to the outflow of
urine.

4. Hydronephrosis of the kidney, with marked dilation of the pelvis and calyces
and thinning of the renal parenchyma.

5. Causes of hydronephrosis
• Hydronephrosis refers to dilatation of renal pelvis
and calyces with accompanying atrophy of
parenchyma.
• Cause by obstruction to outflow of urine

6. Causes of hydronephrosis
Congenital
• Atresia of urethra,
• Aberrant renal artery compressing the ureter,
• Renal ptosis with kinking of ureter.

7. Causes of hydronephrosis
Acquired:
• Foreign Body: Stones
• Tumors: cancer prostate & bladder tumors
• Inflammation: prostatitis, ureteritis, urethritis
• Neurogenic: spinal cord damage with paralysis of
bladder.

8. Causes of hydronephrosis

9. PATHOPHYSIOLOGY
Due to the etiological factors
Obstruction of the urine flow
Fluid backs up into the kidney Causing dilatation of
renal pelvis
Results in barotraumas/pressure trauma

10. Higher pressure causes irreversible
destruction of the nephrons
Hypertrophy of the kidneys as a
consequence of increased workload
Hydronephrosis
Renal failure

11. Morphology :
• The kidney is massively enlarged with greatly
distended pelvi-calyceal system.
• The renal parenchyma is compressed and atrophied
with obliteration of the papilla and fattening of the
pyramids.
• One or both ureter may also dilated (hydroureter)

12. Hydroureter & hydronephrosis

13. TYPES OF HYDRONEPHROSIS

14. Symptoms and signs of hydronephrosis
1. asymptomatic (in some cases)
2. pain is felt in the renal area
3. hematuria
4. Anuria/ oliguria
5. urinary infection, dysuria, frequency
6. Calculi
7. Azotemia
8. unexplained vague GI symptoms
9. some large hydronephrosis can be palpable
10. Distension of bladder if urethra is obstructed

15. Clinical course
• Bilateral complete obstruction produce anuria
which need soon medial attention
• Incomplete bilateral obstruction produce polyuria
rather than oliguria as a result of defect in tubular
concentrating mechanism

16. Clinical course
 Unilateral hydronephrosis may be silent for long
period unless other kidney is affected.
 Bilateral hydronephrosis usually lead to renal failure.
 Early removal of obstruction can return the kidney
function.

17. Treatment of Hydronephrosis secondary to a cause
• Stones -Pyelolithotomy, Ureterolithotomy
• Stricture -Stricturoplasty or excision and end to end anastomosis
• Aberrant Vessel -Transection of the ureter and anastomosis in front of
the vessel
• Benign Prostatic Hyperplasia -Transurthral resection of Prostate (TURP)
• Carcinoma of Prostate -TURP+ Hormonal Therapy
• Urethral Stricture -Urethroplasty
• Meatal Stenosis - Meatoplasty
• Phimosis -Circumcision

18. • Indications for Surgery in case of Hydronephrosis are
Pain
Atrophy of kidney (Cortical thinning)
Infection
Nephrosis (Increasing Hydronephrosis)

19. A Case of Hydronephrosis
Middle aged female presented with symptoms of loin pain,
Ultrasonography of abdomen revealed dilatation of pelvic-calyceal
system and renal cortical thickness as 5mm.

20. Management of Hydronephrosis
Cortical Thickness is
adequate i.e. more than
or equal to 5mm
Preliminary
Nephrostomy should be
done to decompress the
system
Reassessment of
renal function to be
done after few days
**If the Kidney is non-functioning with thinned out cortex i.e. less than
5mm ,nephrectomy should be performed.

21. Management of Renal Stones
£ 3
Z2
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Pyelolithotomy
Percutaneous
Nephrolithotomy
Modern Methods of
Stone Removal
Considering that after nephrostomy, renal function has
improved and the cause of hydronephrosis in this case was
renal calculus. Further management can be done as follows :
Nephrolithotomy

22. Management of Congenital Hydronephrosis
• Patients with Congenital PUJ dysfunction ,present with congenital
Hydronephrosis.
• Congenital Hydronephrosis can be defined as more than 10mm
antero-posterior diameter of renal pelvis at 20 weeks of gestation.
• Management differs according to the grade of hydronephrosis,
which is based on renal pelvic diameter.

23. Anderson Hynes Pyeloplasty
• In this operation , the upper third
of the ureter and the renal pelvis
are mobilized.
• Anastomosis is made between
ureteric end and kidney.
• A Nephrostomy tube is passed ,
which serves to protect the
anastomosis.