Urology 4: Hydronephrosis

Contents

Definition
Etiology
Pathology
Clinical features
Special investigations
Treatment

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

Hydronephrosis

Normal kidney

Hydronephrosis

Normal Intravenous Pyelogram

(IVP)
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Intravenous Pyelogram (IVP) Showing

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Hydronephrosis

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

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:
Dietls 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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