Hydronephrosis

Amarendra B. Singh090201263

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Definition

• Hydronephrosis is the aseptic dilatation of the renal pelvis or calyces.

• It may be associated with obstruction but may be present in the absence of obstruction.

• There is accompanied destruction of kidney parenchyma.

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Etiology

• It can be Unilateral or bilateral.

• Unilateral maybe extramural, intramural or Intraluminal

• Bilateral causes are either congenital or acquired

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Unilateral hydronephrosis

• By some form of ureteric obstruction, with the ureter above the obstruction being dilated.

CausesA. Extramural obstructionB. Intramural (in the walls)C. Intraluminal

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Causes of Unilateral hydronephrosis

A. Extramural1. Obstruction by Aberrant renal vessels (vein or

artery). It is common on left side.2. Compression by growth ( CA cervix, carcinoma

rectum)3. Retroperitoneal fibrosis (Ormond disease)4. Retrocaval ureter

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B. Intramural1. Congenital PUJ obstruction

2. Ureterocele

3. Neoplasm of ureter4. Narrow ureteric orifice5. Stricture ureter following removal of stone, pelvic

surgeries or tuberculosis of ureter.

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C. Intraluminal1. Stone in the renal pelvis2. Sloughed papilla in papillary necrosis

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Bilateral Hydronephrosis

• Result of urethral obstruction ; but may also be caused by one of the lesions described above occurring on both sides

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Causes of Bilateral hydronephrosis

A. Congenital• Congenital stricture of external urethral meatus, pin-hole meatus.• Congenital posterior urethral valve.

B. Acquired• BPH• Carcinoma prostate• Postoperative bladder neck scarring• Inflammatory / traumatic urethral stricture• Phimosis • Carcinoma cervix• Bladder carcinoma

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Classification • Classification I

— Unilateral HN— Bilateral HN without renal failure— Bilateral HN with renal failure

• Classification II– Intermittent HN

– Persistent HN

• Classification III– HN only

– HN with hydroureter

• Classification IV– Extrarenal pelvic HN (80%)

– Intrarenal pelvic HN (20%)