Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to Hydronephrosis: Causes, Symptoms, and Treatment
Similar to Hydronephrosis: Causes, Symptoms, and Treatment (20)
Recently uploaded
Recently uploaded (20)
Hydronephrosis: Causes, Symptoms, and Treatment
- 1. Hydronephrosis Submitted by ; Vinayak Ambekar
- 2. Definition • Hydronephrosis is defined as aseptic dilatation of the whole or a part of the pelvi-calyceal system of the kidney due to partial or intermittent interruption to the outflow of urine.
- 3. Hydronephrosis of the kidney, with marked dilation of the pelvis and calyces and thinning of the renal parenchyma.
- 4. Causes of hydronephrosis • Hydronephrosis refers to dilatation of renal pelvis and calyces with accompanying atrophy of parenchyma. • Cause by obstruction to outflow of urine,
- 5. Causes of hydronephrosis Congenital • Atresia of urethra, • Aberrant renal artery compressing the ureter, • Renal ptosis with kinking of ureter.
- 6. Causes of hydronephrosis Acquired • Foreign Body: Stones • Tumors: cancer prostate & bladder tumors • Inflammation: prostatitis, ureteritis, urethritis • Neurogenic: spinal cord damage with paralysis of bladder.
- 10. • The kidney is massively enlarged with greatly distended pelvi-calyceal system. • The renal parenchyma is compressed and atrophied with obliteration of the papilla and fattening of the pyramids. • Depending on obstruction one or both ureter may also dilated (hydroureter) Morphology :
- 13. Severe hydronephrosis . The kidney is markedly enlarged.
- 14. Hydronephrosis affecting mainly the lower pole of kidney due to stone at this site .The upper pole of the kidney is normal
- 17. • Bilateral complete obstruction produce anuria which need soon medial attention • Incomplete bilateral obstruction produce polyuria rather than oliguria as a result of defect in tubular concentrating mechanism Clinical course
- 18. • Unilateral hydronephrosis may be silent for long period unless other kidney is affected. • Bilateral hydronephrosis usually lead to uremia. • Early removal of obstruction can return the kidney function. • However with the time the changes become irreversible. Clinical course
- 19. Treatment of Hydronephrosis secondary to a cause • Stones Pyelolithotomy, Ureterolithotomy • Stricture Stricturoplasty or excision and end to end anastomosis • Aberrant Vessel Transection of the ureter and anastomosis in front of the vessel • Benign Prostatic Hyperplasia Transurthral resection of Prostate (TURP) • Carcinoma of Prostate TURP+ Hormonal Therapy • Urethral Stricture Urethroplasty • Meatal Stenosis Meatoplasty • Phimosis Circumcision
- 20. A Case of Hydronephrosis • Middle aged female presented with symptoms of loin pain, ?? Ultrasonography of abdomen revealed dilatation of pelvic-calyceal system and renal cortical thickness as 5mm. • Indications for Surgery in case of Hydronephrosis are Pain Atrophy of kidney (Cortical thinning) Infection Nephrosis (Increasing Hydronephrosis) **Indications can be remembered by mnemonic ‘PAIN’
- 21. Management of Hydronephrosis in this case Cortical Thickness is adequate i.e. more than or equal to 5mm Preliminary Nephrostomy should be done to decompress the system Reassessment of renal function to be done after few days If Renal function improves , depending on the cause definitive surgery for hydronephrosis can be done If the renal function doesn’t improve and the opposite kidney is normal , nephrectomy is done**If the Kidney is non-functioning with thinned out cortex i.e. less than 5mm ,nephrectomy should be performed.
- 22. Management of Renal Stones • Considering that after nephrostomy, renal function has improved and the cause of hydronephrosis in this case was renal calculus. Further management can be done as follows : Management of Renal Stones Modern Methods of Stone Removal Extra-corporeal shock wave lithotripsy Percutaneous Nephrolithotomy Open Surgery for Stone Removal Pyelolithotomy Nephrolithotomy
- 23. Management of Congenital Hydronephrosis • Patients with Congenital PUJ dysfunction ,present with congenital Hydronephrosis. • Congenital Hydronephrosis can be defined as more than 10mm antero-posterior diameter of renal pelvis at 20 weeks of gestation. • Management differs according to the grade of hydronephrosis, which is based on renal pelvic diameter.
- 24. • Grading is as follows, Mild 11-20mm ,Moderate 21-35mm, Severe >35mm. • Mild hydronephrosis is managed conservatively with serial monitoring of pelvic diameter by ultrasound and of renal function • Moderate hydronephrosis is also managed by serial monitoring. Any deterioration of renal function is an indication for surgical intervention. • Severe Hydronephrosis should be treated early-Anderson Hynes Pyeloplasty to prevent permanent damage to kidney.
- 25. Anderson Hynes Pyeloplasty • In this operation , the upper third of the ureter and the renal pelvis are mobilized. • Anastomosis is made between ureteric end and kidney. • A Nephrostomy tube is passed , which serves to protect the anastomosis.