Management of

Hydronephrosis

BRAJESH LAHRI

FINAL PROFESSIONAL MBBS

ALL INDIA INSTITUTE OF MEDICAL SCIENCES (AIIMS),BHOPAL

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.

Aetiology of Hydronephrosis

Hydronephrosis

Congenital

Hydronephrosis (due

to pelvi-ureteric

junction dysfunction)

Hydronephrosis due to a secondary

cause

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

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’

Management of Hydronephrosis in this

case

Cortical Thickness is

adequate i.e. more

than or equal to

5mmPreliminary

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.

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

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.

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.

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.