What is hydronephrosis and how does it develop?
The kidney continuously produces urine, which collects in the calyces and pelvis, and then flows through the ureter into the bladder. If an obstacle arises along this path, urine continues to flow, but cannot come out: the pressure in the pelvis increases, it stretches.
Increased pressure is transmitted to the kidney tissue. First, its ability to concentrate urine suffers, then the nephrons, the functional units of the kidney, begin to die. Over time, the renal parenchyma becomes thinner, and in its place a thin-walled sac filled with urine forms.
The speed of this process depends on the degree and nature of the obstruction. With a complete acute block, irreversible changes develop over several weeks, with a partial chronic block - over months and years.
Causes of hydronephrosis
The causes are usually divided into congenital and acquired, as well as internal (inside the urinary tract) and external (compression from the outside).
- Congenital narrowing of the ureteropelvic segment is the most common cause in children and young people
- An additional vessel that compresses the ureter at the exit from the pelvis
- Kidney or ureteral stone
- Cicatricial stricture of the ureter after inflammation, trauma, prolonged stone formation or previous operations
- Vesicoureteral reflux
- Ureterocele and other anomalies of the ureteral orifice
- Prostate adenoma, urethral stricture, sclerosis of the bladder neck - cause bilateral hydronephrosis
- Tumors of the ureter, bladder, pelvic organs
- Retroperitoneal fibrosis
- Pregnancy - physiological expansion due to compression of the ureters by the uterus
- Neurogenic bladder
Symptoms
The main feature of hydronephrosis is the paucity of complaints. With slow development, the kidney gradually stretches, and the body has time to adapt.
- Dull, aching pain or heaviness in the lower back, sometimes without a clear connection with the load
- Paroxysmal pain, if the cause is a stone
- Increased pain after drinking large amounts of liquid
- Palpable formation in the hypochondrium with pronounced expansion
- Blood in urine
- Increased blood pressure
- Recurrent urinary tract infections
- General symptoms for bilateral lesions: weakness, nausea, swelling, decreased urine output
- In children - growth retardation, repeated rises in temperature for no apparent reason, abdominal pain
Diagnostics
- Ultrasound of the kidneys - reveals expansion and allows you to assess the thickness of the parenchyma
- CT urography - determines the level and cause of the obstruction
- Excretory urography - evaluates excretory function
- Dynamic nephroscintigraphy is a key study: it shows how much function the kidney has retained and whether there is true obstruction
- Retrograde ureteropyelography - accurate visualization of the level of narrowing before surgery
- MRI urography - for contrast intolerance or in children
- Creatinine, urea, blood electrolytes
- General analysis and urine culture
- Measuring blood pressure over time
The key question of the examination is not “how dilated the pelvis is,” but “whether the kidney function is preserved and whether it continues to deteriorate.” It depends on the answer whether an operation is needed and what kind.
Treatment
Treatment of hydronephrosis is always aimed at the cause. The enlargement of the pelvis itself cannot be treated with either tablets or herbs.
- Ureteral stenting - rapid restoration of urine outflow, often as the first stage
- Percutaneous nephrostomy - drainage of the kidney through a puncture in the lower back in case of infected hydronephrosis or the inability to insert a stent
- Removal of the stone that caused the obstruction - contact crushing, ESWL or percutaneous surgery
- Laparoscopic pyeloplasty - reconstruction of the narrowed ureteropelvic segment; modern standard for congenital obstruction
- Open ureteropyeloanastomosis - for complex anatomy or repeated interventions
- Ureterocystoneostomy - transplantation of the ureter into the bladder in case of damage to its lower part
- Balloon dilatation and bougienage of ureteral stricture - for short narrowings
- Treatment of prostate adenoma or urethral stricture - with bilateral hydronephrosis caused by obstruction of the bladder outlet
- Nephrectomy - removal of the kidney if it has completely lost function and is a source of infection or hypertension
Forecast and what affects the result
- The sooner the obstacle is removed, the greater the chance of restoring function.
- Thin parenchyma on ultrasound and low percentage of function on scintigraphy are signs of irreversible changes
- After a successful operation, the dilation of the pelvis does not decrease immediately and may be partially preserved - this does not always mean failure
- Monitoring is required for several years after surgery: stricture recurrence is possible
- With a bilateral process, the prognosis is determined by the total renal function
Where is hydronephrosis treated in Tashkent
Hydronephrosis requires accurate diagnosis of the level of obstruction and assessment of kidney function, and treatment often involves reconstructive surgery - pyeloplasty or ureter transplantation.
In Tashkent, examination and treatment of hydronephrosis, including stenting, nephrostomy and laparoscopic pyeloplasty, are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If hydronephrosis is discovered by chance on an ultrasound and nothing worries you, this is not a reason to postpone the visit. The sooner the cause is determined, the higher the chance of saving the kidney. Clinic contacts are below.
