Hydronehrosis

by
Hassaan Ali Gad
Assistant lecturer of urology
Aswan University
Diagnosis And Management Of
Hydronephrosis

Agenda
 DEFINITION
 ETIOLOGY
 PATHOLOGY
 CLINICAL FEATURES
 INVESTIGATIONS
 TREATMENT
hassan.ali@aswu.edu.eg

Definition
Aseptic progressive dilatation of the pelvi-calyceal
system resulting from the volume overload on the
upper urinary tract.

Etiology
I) Obstructive causes :
II) Reflux causes :
UNILATERAL
 BILATERAL

Any obstructive causes from PUJ to VUJ
intra-luminal ,luminal or extra-luminal
 CONGENITAL
 INFLAMMATORY
 NEOPLASTIC
 TRAUMATIC
 STONES
Obstructive causes

Reflux causes
Urine reflux through the UVJ into the ureter upwards the
kidney
 Primary vesico-ureteral reflux:
 Secondary vesico-ureteral reflux:
infra-vesical obstructions from the bladder neck down to the
external urethral meatus.
 CONGENITAL
 INFLAMMATORY
 NEOPLASTIC
 TRAUMATIC
 STONES
• NEUROGENIC

Pathogenesis :
Presence of obstruction or reflux will result in
a volume overload which leads to gradual
increase in the intracalyceal pressure which
will lead to compression of the blood supply
resulting in parenchymal ischemia that ends
by parenchymatous atrophy.

course and stages
1. Mild hydronephrosis : Renal calyces become flat then clubbed
and lately become ballooned; the parenchyma between the
minor calyces are thinned out but is still present i.e. the
kidney still has minor and major calyces.
2. Moderate hydronephrosis : the parenchyma between the
calyces are eaten up so the kidney becomes with major
calyces without minor calyces.
3. Advanced hydronephrosis : Both minor and major calyces are
lost and the kidney becomes as a sac of urine.
 Functioning.
 Non functioning.

Terms according to extent of dilatation:
 Hydrocalyx : Dilatation of a renal calyx.
 Hydropelvis: Dilatation of the renal pelvis.
 Hydronephrosis: Dilatation of the pelvi-calyceal system.
 Hydroureter: Dilatation of the ureter.
 Hydro-uretero-nephrosis: Dilatation of both the ureter and
kidney

Clinical manifestations
 Obstructive cases :
 Colicky pain:
 Renal pain:
 Renal swelling
 Gastro-intestinal manifestations : As dyspepsia.
 Manifestations of complications : e.g. ruptured kidney,
infections, hematonephrosis.
 Manifestations of chronic renal failure:

Reflux cases
 LUTs /BPH
 Chronic retention : gradual increase in the
amount of residual urine inside the bladder
 Chronic retention with overflow incontinence.
 Renal pain.
 Renal infections.
 Renal swelling : The kidney size is normal or
slightly enlarged
 Chronic Renal Failure manifestation

Characteristics of hydronephrotic swelling by
examination:
• Oblong lobulated surface cystic with
rounded borders.
• Felt in the loin, or can be pushed in
the loin.
• Directed downwards.
• The hand can be insinuated between
it and the costal margin
• ballotable mass
• renal contact.

Investigations :
- RADIOLOGICAL
- LABORATORY
laboratory :
 Urine analysis and culture and sensitivity test
 Renal function testes
 Electrolytes( Na K Ph)

Radiological
 Abdominal ultrasonography
 Plain X-Ray urinary tract (KUB film)
 CT-UT with or without contrast
 Intravenous urography (IVU)
 Voiding cystourethrography(VCUG) :
 Antegrade nephrostography or Retro-grade
pyelography:
 MRU
 Renogram

Treatment of hydronephrosis :
According to :
 Unilateral hydronephrosis
 Bilateral hydronephrosis
 Solitary kidney
 Compensated patient
 decompensate patient
 Functioning or non Functioning

Patient with a solitary kidney
Compensated patient : Treatment of the
cause.
Decompensated patient
Urinary diveration (PCN or JJ)
Dialysis + (PCN or JJ)
Then
 treatment of the cause.
 Regular dialysis and renal transplantation

Unilateral hydronephrosis :
 Functioning kidney:
Treatment of the cause.
 Non-functioning kidney :
± Nephrectomy

Bilateral hydronephrosis :
 Decompensated patient :
 ± Dialysis + PCN treatment of the cause.
We can begin with ;
 The better side, if equally affected, begin with
 The painful side, if equally affected, begin with
 The infected side.
 Regular dialysis and renal transplantation

Bilateral hydronephrosis :
 1. Compensated patient :
Treatment of the cause and we begin with ;
 The worst side, but if equally affected , we begin with
 The painful side, but if equally affected, we begin with
 The infected side.

Any Questions ?

Thank you

Hydronehrosis

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