Hydronephrosis_Presentation part122.pptx

Hydronephrosis Presentation

1. Hydronephrosis Postgraduate Surgery Presentation

2. Definition Hydronephrosis refers to dilatation of the renal pelvis and calyces due to obstruction of urinary outflow, leading to progressive atrophy of renal parenchyma.

3. Etiology 1. Congenital causes: - Pelviureteric junction obstruction - Vesicoureteral reflux - Posterior urethral valves 2. Acquired causes: - Urolithiasis - Ureteral strictures - Tumors (e.g., pelvic or bladder) - Pregnancy - Retroperitoneal fibrosis

4. Pathophysiology Obstruction leads to increased hydrostatic pressure in the renal pelvis, which causes progressive dilation, compression of renal vasculature, and ischemic atrophy of the renal parenchyma.

5. Clinical Features • Flank pain or abdominal mass • Recurrent urinary tract infections • Hematuria • Oliguria or anuria (if bilateral) • Hypertension • May be asymptomatic and detected incidentally

6. Investigations 1. Urinalysis: Pyuria, hematuria 2. Blood tests: Urea, creatinine 3. Ultrasound: First-line imaging; detects dilation 4. CT Urogram: Defines level and cause of obstruction 5. Diuretic renography (MAG3/DTPA): Differentiates obstructive vs non-obstructive hydronephrosis

7. Management 1. Relieve obstruction and preserve renal function. 2. Temporary drainage: Nephrostomy or ureteral stent. 3. Definitive treatment depends on cause: - Stone removal (URS/PCNL) - Pyeloplasty for PUJ obstruction - Tumor resection - Valve ablation in posterior urethral valves

8. Complications • Chronic renal failure • Hypertension • Urinary tract infections • Pyonephrosis • Irreversible renal damage if untreated

9. Summary Hydronephrosis is a progressive condition due to obstruction of urinary flow. Early diagnosis and management are essential to prevent irreversible renal damage. Treatment aims to relieve obstruction and preserve renal function.