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HYDRONEPHROSIS.ppt
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- 2. CONTENTS • Definition • Etiology •Pathology • Clinical features • Special investigations • Treatment 2
- 3. DEFINITION • Aseptic dilatationof renal pelvis & calyces with accompanying destruction of the kidney parenchyma • Usually due to partial obstruction to the outflow of urine • Infected hydronephrosis is bacterial infection in a hydronephrotic Kidney • The term pyonephrosis refers to Infected hydronephrosis associated with suppurative destruction of parenchyma of kidney, in which there is total or nearly total loss of renal function 3
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- 6. Normal Intravenous Pyelogram(IVP) 6
- 7. Intravenous Pyelogram (IVP)Showing Hydronephrosis 7
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- 9. Etiology • Primary orsecondary • Primary: idiopathic • Secondary: maybe unilateral or bilateral 9
- 10. Causes of unilateralhydornephrosis • Maybe extramural, intramural or Intraluminal • Extramural: – Pressure on the ureter by loaded sigmoid colon, gravid uterus, uterine & ovarian tumors – Involvement of the ureter by malignant neoplasm outside it e.g. carcinoma of the cervix, uterus, colon, rectum, prostate – Aberrant renal vessels – Idiopathic retroperitoneal fibrosis 10
- 11. Causes of unilateralhydornephrosis • Intramural: – Congenital stenosis or achalasia of the PUJ – Ureterocele – Stricture – Neoplasm of ureter 11
- 12. Causes of unilateralhydornephrosis • Intraluminal: – Calculus – Congenital folds at the upper end of the ureter 12
- 13. Causes of bilateralhydornephrosis • Due to pathologies in the urethra or the urinary bladder • Causes in the urethra: – Pin – hole meatus – Congenital valves – BPH & carcinoma of prostate – Stricture – Carcinoma of cervix & uterus 13
- 14. Causes of bilateralhydornephrosis • Due to pathologies in the urethra or the urinary bladder • Causes in the bladder: – Calculus – Neoplasms – Sphincter dysfunction 14
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- 17. Pathophysiology • Dilatation ofthe renal pelvis & calyces • Types of hydronephrosis: – Pelvic type – Renal type – Pelvirenal type: most common type, both the pelvis & calyces are equally dilated 17
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- 19. 19 Pathology • There iscalyceal dilatation and the renal parenchyma is destroyed by pressure atrophy. • A kidney destroyed by longstanding hydronephrosis is a thin-walled, lobulated, fluid-filled sac. N. S.Williams et al, The Kidney and Ureters ,Bailey & Love's Short Practice of Surgery. 25th Edn USA : Hodder Arnold, 2013
- 20. Clinical features • Maydepend on unilateral, intermittent or bilateral hydronephrosis • Bilateral hydronephrosis: – Features of the causes – Bilateral renal swelling 20
- 21. Clinical features • Maydepend on unilateral, intermittent or bilateral hydronephrosis • Bilateral hydronephrosis: – Features of the causes – Bilateral renal swelling 21
- 22. Special investigations • X-ray KUB • Excretory urography • Retrograde urography • Ultrasound • Nuclear renography • Computed Tomography • Magnetic Resonance Imaging 22
- 23. Whitakar Test: • Studyinvolves measurement of renal pelvic pressure during infusion of either saline or contrast material into the collecting system through a percutaneous needle or nephrostomy at a fixed rate of 10ml/min . A catheter is placed in the bladder to monitor intravesical pressure, which is subtracted from the measured collecting system pressure to calculate the “true pressure” within the pelvis. • Inference: Intrapelvic pressure Normal : Less than 15cmH2O Obstruction : Greater than 22cmH2O Intermediate : Between 15 and 22 cmH2O 23
- 24. Treatment • Secondary hydronephrosis:treatment of the cause • Primary hydronephrosis: – Pyeloplasty: • Anderson- Hynes • Culp • Foley – Nephrectomy 24
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- 29. Principles of pyeloplasty •To reduce the size of the renal pelvis • Excision of the PUJ • The ureter is attached to the most dependent part of the pelvis 29
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- 31. 31 extraperitoneal flank approach, bedof the twelfth rib
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