Dept. Of Urology. shanghai Renji hospital WANG YIXIN Hydronephrosis Dept. Of Urology. shanghai Renji hospital WANG YIXIN

Etology of hydronephrosis 1.Primary hydroneprosis intrinsic strinsic strictrue high insertion of the ureter PUJ nephroptosis extrisic compresion renal pelvis stone or tumor

Etology of hydronephrosis 2.Secondary hydronephrosis visicoureteral reflux obstruction distal to the ureteropelvic junction: stone, tumor, extrinsic ureteral compression, myoneurogenic disease, ureterocele, CAB, ca of pelvic viscera bladder outer obstruction: CAP, BPH urethral obstruction pregnancy

Pathology of hydronephrosis 1.first shows evidence of hyperactivity and hypertrophy than dilatation and atony 2.muscular loss of peristaltic activity 3.atrophy of the renal parenchyma 4.compression of the arcuate vessels ischmic atrophy

Symptoms and signs of hydronephrosis 1.asymptomatic (in some cases) 2.pain is felt in the renal area 3.hematuria 4.urinary infection, dysuria frequency 5.calculi 6.azotemia 7.unexplained vague GI symptoms 8.some large hydronephrosis can be palpable

Diagnosis of hydronephrosis 1. symptoms and signs 2. ultrasound 3. IVU 4. Cystourethralgram 5. Cystoscopy 6. RGP 7. Delayed empty 8. Isotope renography 9.urine culture

Treatment of hydronephrosis 1. U.T.I. Antibiotic therapy 2. Prompt drainage 3 corrected to the cause 4. Relief of lower tract obstruction catheter drainage ,urinary diversion , indwelling pigtail ureteral catheter 5. Nephrectomy( tumor or nonfunction kidney)

Prognosis of hydronephrosis Deponds on the cause ,site, duration , and degree of kidney damage .