3. EVALUATION
Depending upon the presentation and
whether there is acute onset of symptoms,
•Physical examination - tenderness in the flank or
where the kidneys are located.
•The bladder - distended when the abdomen is
examined.
•PR for males shows the size of the prostate. 50
4. Pelvic examination in females may be performed
to evaluate the uterus and ovaries.
5. •Urine analysis to look for blood, infection or abnormal
cells
•Complete blood count (CBC) may reveal anemia or
potential infection
•Electrolyte analysis may be helpful in chronic
hydronephrosis since the kidneys are responsible for
maintaining and balancing their concentrations in the
blood stream.
51
6. X RAY KUB
KUB X-rays (an X-ray that shows the kidney,
ureter, and bladder) are used to classify a
kidney stone as radiodense or radiolucent.
KUB X-rays are used to determine if the
stone is able to migrate down the ureter
into the bladder.
52
9. IVP
• IVP : Dilatation of renal
pelvis decreasing
concavity and then
flattening of minor
calyces with dilatation
of major calyces a
portion of pelvis
becomes more
dependant part below
the level of PVJ 53
14. Retrograde Pyelogram (RP)
Retrograde pyelogram is used to determine
whether stone or other thing that is
obstructing the urinary pathway.
This is used in Some people with contra
indictions for IVP in which dye is introduced
into the veins.
15.
16. •CT scan of the abdomen can be done to
evaluate the kidney anatomy and it will help
in making the diagnosis of hydronephrosis.
•It also may allow look for the underlying cause
including kidney stones or structures that are
compressing the urinary collecting system.
CT scan
17. PRINCIPLES OF TREATMENT
In adults, the aims of treatment are to:
•Remove the build-up of urine and relieve
tthe pressure on kidneys.
•Prevent permanent kidney damage.
•Treat the underlying cause
18. • Most people with hydronephrosis should have
catheterisation to drain the urine from their
kidneys.
• Depending on the underlying cause, medication
or surgery may be needed afterwards to correct
the problem.
• If the condition is severe or causing problems
such as a urinary tract infection (UTI), it may be
treated soon after it is diagnosed.
19. •The first stage in treating hydronephrosis is to
drain the urine out of the kidneys. This will help
ease pain and prevent any further damage to
kidneys.
•A thin tube called a catheter may be inserted into
your bladder through urethra or through spc.
20.
21. TREATMENT GOAL
•
•
•
•
The goal of treatment for hydronephrosis is to restart the
free flow of urine from the kidney and decrease the
swelling and pressure that builds up and decreases
kidney function.
The initial care for the patient is aimed at minimizing
pain and preventing urinary tract infections.
The timing of the procedure depends upon the
:underlying cause of hydronephrosis and hydroureter
and the associated medical conditions that may be
present. 60
22. For example, patients with a kidney stone may be
allowed 1-2 weeks to pass the stone with only
supportive pain control if urine flow is not
completely blocked by the stone.
If, however, the patient develops an infection or if
they only have one kidney, surgical intervention
may be done emergently.
To remove the stone.
23. For patients with urinary retention and an
enlarged bladder as a cause of hydronephrosis,
bladder catheterization may be all that is
needed for initial treatment.
When a stent cannot be placed, an alternative
is inserting a percutaneous nephrostomy
tube. A urologist or interventional radiologist
uses fluoroscopy to insert a tube through the
flank directly into the kidney to allow urine to
drain.
61
25. Shock wave lithotripsy(SWL )
Shock wave lithotripsy(SWL or
extracorporeal shock wave
lithotripsy) is the most common
treatment for kidney stones.
Shock waves from outside the
body are targeted at a kidney
stone causing the stone to
fragment into tiny pieces that
are able to be passed out of the
urinary tract in the urine. 62
26. For patients with ureteral
strictures or stones that are
difficult to remove, stent may
be placed into the ureter that
bypasses the obstruction and
allows urine to flow from the
kidney.
63
27. Using a fiber optic scope inserted through the
urethra into the bladder, can visualize where the
ureter enters and can thread the stent through
the ureter into the kidney pelvis bypassing any
obstruction.
28. Treating hydronephrosis in babies
Most babies diagnosed with hydronephrosis
before they're born (antenatal hydronephrosis)
won't need any treatment because the condition
will improve before they're born or within a few
months of their birth.
Investgiations are done for babies like:
•An ultrasound scan
Micturating cystourethrogram (MCUG) – where a
thin tube is used to pass a special type of liquid
that shows up clearly on X-rays into thebaby's
bladder while a series of X-rays are taken.
29. Dimercaptosuccinic acid (DMSA) scan or MAG-3 scan –
where they are injected with a substance that shows up
on a special device called a gamma camera; the camera is
then used to take pictures of child's kidneys
In most children, hydronephrosis will get better as they
get older.
If hydronephrosis doesn't get better by itself, your
child may need to keep taking antibiotics.
Occasionally, surgery may be recommended to treat
the underlying cause of the condition
30. INDICATIONS OF OPERATIONS :
•Increasing renal pain increasing hydronephrosis
•When hydronephrosis is complicated by
infection/parenchymal damage.
PROCEDURES : Nephrectomy
•Plastic operations
•Endoscopic pyelolysis / endoscopic pyelotomy
•Endoscopic ballon dilatation
31. 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
35. Anderson- Hynes Pyeloplasty :
In this procedure , upper one third of ureter
and Renal pelvis are mobilised
Anastamosis is made between ureteric end
and kidney
A Nephrostomy tube was placed in order to
protect the anastamosis
36. Stitches are placed on the renal pelvis superior to the
obstruction and the lateral aspect of the proximal ureter
below the level of the obstruction.
b The ureteropelvic junction tissue is then excised and an
anastomosis is created with fine interrupted or running
absorption sutures.
c The sutures are placed in a watertight manner over an
internal ureteral stent, which remains in situ.
72
37. 73
A spiral incision is made in the enlarged renal pelvis and
extended an equal distance into the ureter.
b | The tissue flap is turned down and stitched into the
adjacent ureter.
c | The flap is closed with fine interrupted or running
absorption sutures.
38. 74
a | The ureter is pulled with a stitch while a Y-shaped
incision is made in the renal pelvis and ureter.
b | A V-shaped flap is opened in the ureteropelvic junction
tissue.
c | The V-shaped flap is sutured to the apex of the ureteral
incision with fine interrupted or running absorption sutures.
39.
40.
41. COMPLICATIONS
• Development of a urinary tract infection (UTI).
• When the UTI is associated with a high fever, a
kidney infection is (pyelonephritis) is suspected.
This is caused by bacteria spreading from the
bladder to the kidney and invading the kidney
tissue.
• If pyelonephritis is severe or not treated in a timely
manner, or if it affects both kidneys, complications
such as permanent kidney damage (kidney scarring)
can lead to problems such as high blood pressure
and sometimes kidney failure. 77
42. ROBOT-ASSISTED
PYELOPLASTY
• A robot-assisted pyeloplasty is a minimally
invasive laparoscopic procedure. With the use
of a tiny camera, surgeons operate using very
thin instruments inserted into three or four
small incisions.
• Robot-assisted pyeloplasty removes an
obstructed section of the ureter and reattaches
the healthy portion to the kidney's drainage
system.
78
