Hydronephrosis

Question 1

What is the definition of hydronephrosis?

Answer 1

Dilation of the renal pelvis

Question 2

How common is hydronephrosis?

Answer 2

Most common in the young and old

Question 3

What is the pathology of hydronephrosis?

Answer 3

• Due to obstruction at any point of between the kidneys and the urethral meatus
• The build up of urine stretches the ureters

Question 4

What are the risk factors/aetiology of hydronephrosis?

Answer 4

• Within the lumen:
• Calculus
• Tumour of renal pelvis/ureter
• Blood clot
• Sloughed renal papillae – diabetes, sickle cell disease
• Within the lumen:
• Congenital abnormalities
• Strictures
• Outside the lumen:
• Prostatic hypetrophy/tumour
• Gynaecological cancer/calculi
• Pregnancy

Question 5

What are the signs/symptoms of hydronephrosis?

Answer 5

• Palpable kidney – depending on where the obstruction is
• Upper tract obstruction:
• Dull ache in the flank/loin – provoked by an ↑ in urine volume, unable to lie still, may radiate to iliac fossa/inguinal area/testis/labium
• UTI symptoms e.g. fever
• Haematuria
• Anuria – complete obstruction
• Polyuria - partial obstruction
• Bladder outlet obstruction
• Hesitancy
• Frequency of small quantities of urine
• Poor stream
• Terminal dribbling
• Sense of incomplete emptying

Question 6

What investigations are conducted for suspected hydronephrosis?

Answer 6

• US -1st line
• CT – high sensitivity
• Excretion urography
• Radionuclide studies – for longstanding obstructions
• Retrograde and antegrade pyelography – contrast from the lower to the upper urinary tract or vice versa
• Cystoscopy
• Pressure flow studies

Question 7

What are the surgical treatments for hydronephrosis?

Answer 7

• Removal of obstruction
• Urinary catheter
• Urinary diversion – via indwelling catheter, stent etc.

Question 8

What are the pharmacological treatments for hydronephrosis?

Answer 8

• Alpha blockers – for BPH

* Chemotherapy/radiotherapy – for tumours