urology hydronephrosis
DESCRIPTION
hidronefrosis, urologia, sistema urinario, englishTRANSCRIPT
Urology 4: Hydronephrosis
Contents
• Definition• Etiology• Pathology• Clinical features• Special investigations• Treatment
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Definition
• Dilatation of renal pelvis & calyces with accompanying destruction of the kidney parenchyma
• Usually due to partial obstruction to the outflow of urine
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Hydronephrosis
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Normal kidney Hydronephrosis
Normal Intravenous Pyelogram (IVP)
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Intravenous Pyelogram (IVP) Showing Hydronephrosis7
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Etiology
• Primary or secondary
• Primary: idiopathic
• Secondary: maybe unilateral or bilateral
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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
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Causes of unilateral hydornephrosis
• Maybe extramural, intramural or Intraluminal
• Intramural:– Congenital stenosis or achalasia of the PUJ– Ureterocele– Stricture– Neoplasm of ureter
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Causes of unilateral hydornephrosis
• Maybe extramural, intramural or Intraluminal
• Intraluminal:– Calculus– Congenital folds at the upper end of the ureter
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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
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Causes of bilateral hydornephrosis
• Due to pathologies in the urethra or the urinary bladder
• Causes in the bladder:– Calculus– Neoplasms– Sphincter dysfunction
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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
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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
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Clinical features
• May depend on unilateral, intermittent or bilateral hydronephrosis
• Intermittent hydronephrosis:– Dietl’s crisis
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Clinical features
• May depend on unilateral, intermittent or bilateral hydronephrosis
• Bilateral hydronephrosis:– Features of the causes– Bilateral renal swelling
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Special investigations
• Straight abdomen of the X- ray• Excretory urography• Retrograde urography• Ultrasound
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Treatment
• Secondary hydronephrosis: treatment of the cause• Primary hydronephrosis:
– Pyeloplasty:• Anderson- Hynes • Culp• Foley
– Nephrectomy
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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
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extraperitoneal flank approach, bed of the twelfth rib
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