Urology

1

Forth stage

Surgery (Urology)

Lec-3

د.ﻣﺣﻣد اﻟﺷﮭواﻧﻲ

21/10/2015

Hydronephrosis and pyonephrosis

Hydronephrosis

 Aseptic dilatation of the pelvi-calyceal system
 Obstructive or refluxive            .
 Unilateral or bilateral                  .
 Whole ureter or part of it may be also dilated,,,hydroureteronephrosis 
 Mild, moderate or severe            

Unilateral hydronephrosis

 Extramural
1.     tumor of prostate,colon, cervix,rectum,
2.     retroperitoneal firosis 
3.     retrocaval ureter 
 Mural
1.     PUJO
2.     ureterocele ,congenital megaureter 
3.     ureteric sticure 
4.     neoplasm of ureter 
 Intramural 
1.     stone in the ureter or pelvis
2.     slught papilla 

Bilateral hydronephrosis
Causes:

1. LIKE causes of UNILATERAL  WHEN HAPIN BILATERALY
2. Conginital 
     stricture of external urethral meatus 
     posterior urethral valve
     bladder neck contracture
3. Acquired 
      BPH, ca prostate,post operative bladder neck scarring 
      urethral stricture 
      Neurogenic bladder 

2

Other causes of hydronephrosis 

 VU reflux: due to lower ureteric orifice incompetence, either primary or secondary.
 Pregnancy: high level of progesteron causes ureteric smooth muscle relaxation and 

hence hydronephrosis.

 Residual hydronephrosis (after surgery).

Pathophysiology:

Increased pelvic pressure causes pelvic dilatation, then calyceal dilatation, which results 
in a gradual atrophy of the kidney and its function. In severe and long standing cases the 
kidney is converted into a sac-like structure with complete loss of its function.

Investigations

1- U/S: non invasive and cheap. Can diagnose  Hydronephrosis in utero

2- KUB:Soft tissue shadow

3-IVU: for diagnosis and localize the cause

4- MCU: for diagnosing and grading VU reflux, and posterior urethral valve

3

5- Retrograde pyelography( in non functioning kidney).

6- Whitaker test.

7- Radioisotope renogram.

8-MRI and CT scan

Treatment of hydronephrosis : 

Each case treated accordingly

pyonephrosis

Is an infection in a hydronephrotic kidney 

Causes

1. Infection of hydronephrosis 
2. Follow acute pyelonephritis 
3. Complication of renal stone

-Its usually unilateral 

Clinical features

 Classical triad of symtoms  (anaemia,fever and swilling in the loin)
 If it is due to infected hydronephrosis   ----> high fever,rigor and large swilling 
 Symtoms of cystitis may be prominent 

Investigations

1. GUE…….pyuria 
2. CBP……. leucocytosis 
3. KUB……..stone
4. ULS………hydronephrosis, stones
5. IVU……….hydronephrosis ; poor functioning kidney 

treatment

 Surgical emergency !
1. Drainage of the kidney, by :
      percutanous nephrostomy 
      if the pus is thick by  ---> formal nephrostomy 
2. Parenteral broad specterm antibiotic 
3. Nephrectomy  ( if affected kidney is non functioning  and other kidney is normal)

4

complications
If not treated rapidly :

1. Permenant renal damage
2. septicemia