Urology 4 Hydronephrosis Contents Definition Etiology Pathology Clinical

Urology 4: Hydronephrosis

Contents • • • Definition Etiology Pathology Clinical features Special investigations Treatment 2

Definition • Dilatation of renal pelvis & calyces with accompanying destruction of the kidney parenchyma • Usually due to partial obstruction to the outflow of urine 3

Hydronephrosis 4

Normal kidney Hydronephrosis 5

Normal Intravenous Pyelogram (IVP) 6

Intravenous Pyelogram (IVP) Showing Hydronephrosis 7

8

Etiology • Primary or secondary • Primary: idiopathic • Secondary: maybe unilateral or bilateral 9

Causes of unilateral hydornephrosis • 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

Causes of unilateral hydornephrosis • Maybe extramural, intramural or Intraluminal • Intramural: – – Congenital stenosis or achalasia of the PUJ Ureterocele Stricture Neoplasm of ureter 11

Causes of unilateral hydornephrosis • Maybe extramural, intramural or Intraluminal • Intraluminal: – Calculus – Congenital folds at the upper end of the ureter 12

Causes of bilateral hydornephrosis • 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

Causes of bilateral hydornephrosis • Due to pathologies in the urethra or the urinary bladder • Causes in the bladder: – Calculus – Neoplasms – Sphincter dysfunction 14

15

16

Pathophysiology • Dilatation of the renal pelvis & calyces • Types of hydronephrosis: – Pelvic type – Renal type – Pelvirenal type: most common type, both the pelvis & calyces are equally dilated 17

18

Clinical features • May depend on unilateral, intermittent or bilateral hydronephrosis • Unilateral hydronephrosis: – Dull ache & sense of weight on the affected side of the loin – Causes of the hydronephrosis 19

Clinical features • May depend on unilateral, intermittent or bilateral hydronephrosis • Intermittent hydronephrosis: – Dietl’s crisis 20

Clinical features • May depend on unilateral, intermittent or bilateral hydronephrosis • Bilateral hydronephrosis: – Features of the causes – Bilateral renal swelling 21

Special investigations • • Straight abdomen of the X- ray Excretory urography Retrograde urography Ultrasound 22

Treatment • Secondary hydronephrosis: treatment of the cause • Primary hydronephrosis: – Pyeloplasty: • Anderson- Hynes • Culp • Foley – Nephrectomy 23

24

25

26

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 27

extraperitoneal flank approach, bed of the twelfth rib 28

29

30

31