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Sunday, 24.09.2017, 09:45
Main » Urology » Hydronephrosis - Diagnosis and Treatment 
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Hydronephrosis - Diagnosis and Treatment


Hydronephrosis, hydronephrosis stage, diagnosis and treatment of hydronephrosis

Hydronephrosis (from the Greek hydor - water, and nephros - the kidney) or the transformation of hydro nephrotic - renal disease is characterized by the expansion of its calyx and pelvis, a progressive thinning (hypotrophy) of renal tissue, accompanied by a violation of all basic functions of the kidney.

Hydronephrosis
Hydronephrosis occurs due to violations of the outflow of urine from the renal pelvis and calyces. All of this is also accompanied by a violation of blood circulation in the kidney tissue.

If hydronephrosis is accompanied by an expansion of the ureter, a condition called ureterohydronephrosis. Hydronephrosis occurs in women is 1.5 times more likely than men and often occurs in children. It is believed that hydronephrosis is:
Primary (congenital), hydronephrosis is caused by abnormalities of the upper urinary tract
secondary (acquired) hydronephrosis occurs as a complication of an illness.


And the primary and secondary hydronephrosis may be complicated by secondary infection. The development of hydronephrosis occurs in the presence of urine outflow obstruction in any part of urinary tract:

Obstacles in the urethra and bladder - narrowing of the urethra and out of the bladder, prostate adenoma, stones in the urethra and bladder tumors. Obstacles in the lower urinary tract usually cause bilateral hydronephrosis.

Obstacles in the ureter. They distinguish the following types:
  • caused by external compression of the ureter (chronic cystitis with narrowing of the output parts of the ureters, cancer, tuberculosis, prostate adenoma, compressing the ureter, renal cysts, tumors in organs and tissues near the ureters, bowel disease, the effects of surgery on the abdominal organs, abnormalities of the renal arteries as adjunctive renal artery spreads through the ureter, causing compression).
  • bends, kinks ureters.
  • narrowing of the lumen inside the ureter (valves, "spurs" on the inner shell of the ureters, diverticulum - a blind diverticulum wall of the ureter). All these obstacles usually cause unilateral hydronephrosis.
  • Barriers due to violations of ureteral peristaltic movements. Cause unilateral or bilateral hydronephrosis.




Hydronephrosis develops gradually. There are three stages of its development:

Initially, the urine accumulates in the renal pelvis. Because of the increased pressure in the pelvis, it is stretched. For some time the walls of the pelvis keep it from over-stretching, and kidney function is affected only slightly. Gradually the pelvis is stretched more and more, the wall becomes thinner and begins its second stage.

Expansion of the pelvis (pyeloectasia) and cups (gidrokalikoz) kidneys. Stretched pelvis compresses the renal tissue and pushes it to the periphery. Renal tissue is subjected to compression of the tension between the pelvis and the kidney capsule of dense tissue. 

The thickness of the tissue of the kidneys is reduced, and impaired renal function significantly.

In the third stage, a sharp tissue atrophy of the kidneys, the tissue becomes thinner, the function of the kidney decreases sharply, and in the terminal (final) stage of renal function disappears.

In the initial stages of hydronephrosis does not appear. His exhibit in the event of accidental infection or when ultrasound and X-ray studies. Characteristic symptoms of hydronephrosis does not. Patient can be confusing for back pain, kidney area, aching permanent. Sometimes in the early stages of renal colic occurs. In the future, increased kidney can be felt through the anterior abdominal wall. Quite often there is hematuria (blood in urine).

In the diagnosis of hydronephrosis patient should be a comprehensive survey: blood, urine. Renal ultrasound to determine the increase and the size of the kidney pelvis and calyces, their degree of expansion, the thickness of kidney tissue. An improved method of color Doppler helps to examine the state of the kidney blood vessels. When X-rays are enlarged kidney, the presence of stones in the urinary tract. To determine the degree of renal impairment performed radioisotope study. To clarify the diagnosis may angiography, computed tomography and magnetic resonance.

Hydronephrosis Treatment is primarily aimed at the root cause of the development
hydronephrosis. Conservative treatment is usually ineffective and only applies when the inflammatory process in the kidneys, to ease pain, to lower blood pressure, symptoms of kidney failure and is used as preparation for surgery. In most cases, surgical treatment is being reconstructed renal pelvis system. Methods of reconstruction of the lot, and the type and scope of the operation depends largely on what kind of disease is caused hydronephrosis, from the same depends on the prognosis for the patient later in life. Recently, thanks to the development of laparoscopic treatment hydronephrosis operations are less traumatic way. With a few punctures in the abdominal cavity of the endoscope is introduced with a video camera and various manipulators. Under the control of the video image on the screen make the necessary surgery. By the removal of the kidney is used when the kidney function is almost lost, and the preservation of the kidney is dangerous because of possible complications. Most such an operation performed in elderly patients.



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