Management of hydronephrosis

This PowerPoint presentation describes the management of a case of Hydronephrosis

1. Management of Hydronephrosis Brajesh Lahri Final Professional MBBS ALL India institute of medical sciences ( aiims ),Bhopal

2. Definition Hydronephrosis is defined as aseptic dilatation of the whole or a part of the pelvi-calyceal system of the kidney due to partial or intermittent interruption to the outflow of urine.

3. Aetiology of Hydronephrosis Hydronephrosis Congenital Hydronephrosis (due to pelvi - ureteric junction dysfunction) Hydronephrosis due to a secondary cause

4. Treatment of Hydronephrosis secondary to a cause Stones  Pyelolithotomy , Ureterolithotomy Stricture  Stricturoplasty or excision and end to end anastomosis Aberrant Vesse l  Transection of the ureter and anastomosis in front of the vessel Benign Prostatic Hyperplasia  Transurthral resection of Prostate (TURP) Carcinoma of Prostate  TURP+ Hormonal Therapy Urethral Stricture  Urethroplasty Meatal Stenosis  Meatoplasty Phimosis  Circumcision

5. A Case of Hydronephrosis Middle aged female presented with symptoms of loin pain, ?? Ultrasonography of abdomen revealed dilatation of pelvic- calyceal system and renal cortical thickness as 5mm. Indications for Surgery in case of Hydronephrosis are P ain A trophy of kidney (Cortical thinning) I nfection N ephrosis (Increasing Hydronephrosis) **Indications can be remembered by mnemonic ‘ PAIN ’

6. Management of Hydronephrosis in this case Cortical Thickness is adequate i.e. more than or equal to 5mm Preliminary Nephrostomy should be done to decompress the system Reassessment of renal function to be done after few days If Renal function improves , depending on the cause definitive surgery for hydronephrosis can be done If the renal function doesn’t improve and the opposite kidney is normal , nephrectomy is done **If the Kidney is non-functioning with thinned out cortex i.e less than 5mm , nephrectomy should be performed.

7. Management of Renal Stones Considering that after nephrostomy, renal function has improved and the cause of hydronephrosis in this case was renal calculus. Further management can be done as follows :

8. Management of Congenital H ydronephrosis Patients with Congenital PUJ dysfunction ,present with congenital Hydronephrosis. Congenital Hydronephrosis can be defined as more than 10mm antero-posterior diameter of renal pelvis at 20 weeks of gestation. Management differs according to the grade of hydronephrosis,which is based on renal pelvic diameter.

9. Grading is as follows , Mild 11-20mm ,Moderate 21-35mm, Severe >35mm. Mild hydronephrosis is managed conservatively with serial monitoring of pelvic diameter by ultrasound and of renal function Moderate hydronephrosis is also managed by serial monitoring. Any deterioration of renal function is an indication for surgical intervention. Severe Hydronephrosis should be treated early -Anderson Hynes Pyeloplasty to prevent permanent damage to kidney.

10. Anderson Hynes Pyeloplasty In this operation , the upper third of the ureter and the renal pelvis are mobilized. Anastomosis is made between ureteric end and kidney . A Nephrostomy tube is passed ,which serves to protect the anastomosis.

11. Thank You