1. بسم الله الرحمن الرحيم Urology
Hydronephrosis

2. Definition:
Hydronephrosis is an aseptic dilatation of the renal pelvis usually caused by obstruction to the outflow of urine.
Hydroureteronephrosis: dilatation of renal pelvis & ureter.
It could be unilateral or bilateral

3. Causes of unilateral ureteric obstruction
Extramural obstruction
■ Tumour from adjacent structures, e.g. carcinoma of the cervix, prostate, rectum, colon or caecum
■ Idiopathic retroperitoneal fibrosis
■ Retrocaval ureter

4. Intramural obstruction
■ Congenital stenosis : narrowing of the pelviureteric junction leading to pelviureteric junction obstruction
■ Ureterocele and congenital small ureteric orifice
■ Inflammatory stricture following removal of ureteric calculus, repair of a damaged ureter or tuberculous infection
■ Neoplasm of the ureter or bladder cancer involving the ureteric orifice

5. Cont. Intraluminal obstruction
■ Calculus in the renal pelvis or ureter
■ Sloughed papilla in papillary necrosis (especially in diabetics, analgesic abusers and those with sickle cell disease) may obstruct the ureter

6. Bilateral hydronephrosis
The lesions described above may occur on both sides.
Bilateral hydronephrosis is usually the result of bladder outlet obstruction
congenital:
– posterior urethral valves
– urethral atresia

7. acquired:
– Benign prostatic enlargement or carcinoma of the prostate – Postoperative bladder neck scarring – Urethral stricture – Phimosis

8. Pathology
There is calyceal dilatation and the renal parenchyma is destroyed by pressure atrophy. A kidney destroyed by longstanding hydronephrosis is a thin-walled, lobulated, fluid-filled sac.

9. Clinical features Unilateral hydronephrosis
Loin pain ( dull or colic ) sometimes associated with palpable loin mass
Bilateral hydronephrosis
From lower urinary obstruction
Symptoms of bladder outflow obstruction predominate.

10. Ureteric dilatation in pregnancy
■Physiological dilatation of the ureter is common in pregnancy
occurs early in pregnancy and becomes more marked until the 20th week
It results from the effects of high levels of circulating progesterone on the ureteric smooth muscle

11. Investigations (Imaging)
Ultrasound scanning: can even diagnose pelviureteric junction obstruction in utero.
IVU: dilated renal pelvis, clubbing of the calyces
Isotope renography
Whitaker test is indicated. A percutaneous puncture of the kidney is made through the loin and fluid is infused at a constant rate with monitoring of intrapelvic pressure.
Retrograde pyelography

12. Imaging
Isotope renogram series shows a late accumulation and persistence of radioactivity in the left kidney (the image is a posterior view).
Ultrasound of a hydronephrotic kidney. A, artery; C, calyces; P, pelvis.

13. Retrograde ureteropyelogram showing hydronephrosis with greatly enlarged pelvis and dilated ‘clubbed’ calyces.

14. Treatment:
treat the cause

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