Urinary system

Hydronephrosis

Dr ;mohamed fawzi alshahwani

بسم الله الرحمن الرحيم

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 tumor of prostate,colon, cervix,rectum, retroperitoneal firosis retrocaval ureter Mural PUJO ureterocele ,congenital megaureter ureteric sticure neoplasm of ureter Intramural stone in the ureter or pelvis slught papilla

Bilateral hydronephrosisLIKE UNILATERAL WHEN HAPIN BILATERALY

Conginital stricture of external urethral meatus posterior urethral valve bladder neck contracture Acquired BPH, ca prostate,post operative bladder neck scarring urethral stricture Neurogenic bladder

Causes of hydronephrosis: Intraluminal ,mural or extramural

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.


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‘ Investigations:

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

2- KUB: Soft tissue shadow

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3-IVU: for diagnosis and localize the cause.

Bilateral hydronephrosis and complete hydroureter.

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

Posterior urethral valve diagnosed by MCU

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5- Retrograde pyelography: in non functioning kidney. 6- Whitaker test. 7- Radioisotope renogram. 8-MRI and CT scan.

CT scan : right hydronephrosis.

Treatment of hydronephrosis
Each case treated accordingly

pyonephrosis

Is an infection in a hydronephrotic kidney Couses Infection of hydronephrosis Follow acute pyelonephritis Complication of renal stone Its usually unilateral

Clinical features

Classical triad of symtoms anaemia,fever and swilling in the loin If due to infected hydronephrosis high fever,rigor and large swilling Symtoms of cystitis may be prominent



Investigations
GUE…….pyoriaCBP……. leucocytosisKUB……..stoneULS………hydronephrosis, stonesIVU……….hydronephrosis ; poor functioning kidney

treatment

Surgical emergency Drinage of the kidney by percutanous nephrostomy if the pus is thick by formal nephrostomy Parenteral broad specterm antibiotic Nephrectomy if affected kidney is non functioning and other kidney is normal

coplication

If not treated rapidley Permenant renal damage septicemia