Hydronephrosis Flashcards
1
Q
What is the definition of hydronephrosis?
A
Dilation of the renal pelvis
2
Q
How common is hydronephrosis?
A
Most common in the young and old
3
Q
What is the pathology of hydronephrosis?
A
- Due to obstruction at any point of between the kidneys and the urethral meatus
- The build up of urine stretches the ureters
4
Q
What are the risk factors/aetiology of hydronephrosis?
A
- 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
5
Q
What are the signs/symptoms of hydronephrosis?
A
- 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
6
Q
What investigations are conducted for suspected hydronephrosis?
A
- 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
7
Q
What are the surgical treatments for hydronephrosis?
A
- Removal of obstruction
- Urinary catheter
- Urinary diversion – via indwelling catheter, stent etc.
8
Q
What are the pharmacological treatments for hydronephrosis?
A
- Alpha blockers – for BPH
* Chemotherapy/radiotherapy – for tumours
