1. Hydronephrosis
Amarendra B. Singh
090201263

2. 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.
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4. Etiology
• It can be Unilateral or bilateral.
• Unilateral maybe extramural, intramural or
Intraluminal
• Bilateral causes are either congenital or
acquired
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5. 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
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6. 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
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7. 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.
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8. C. Intraluminal
1. Stone in the renal pelvis
2. Sloughed papilla in papillary necrosis
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9. Bilateral Hydronephrosis
• Result of urethral obstruction ; but may also
be caused by one of the lesions described
above occurring on both sides
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10. 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
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11. 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