DOI: http://dx.doi.org/10.18203/2349-2902.isj20192360

Unilateral hydronephrosis in adults: etiology, clinical presentations and management

Gowardhan Dare, Murtaza Akhtar, Swanand Chaudhary

Abstract


Background: Hydronephrosis is dilatation of renal pelvis and calyces resulting from intermittent and incomplete obstruction to the urine outflow with incidence of 1:100. This study aims to evaluate etiological factors, clinical presentations, diagnostic modalities and management options of unilateral hydronephrosis.

Methods: In a tertiary care based observational study, patients more than 18 years age of either gender with unilateral loin pain with or without lump in loin were clinically diagnosed as unilateral hydronephrosis and confirmed on imaging studies were enrolled as subjects. Pregnant patients and patients not consenting were excluded. Patients with mild unilateral hydronephrosis were managed conservatively. Those of moderate to severe grade were investigated with CT urography and those with no excretion of dye in affected kidney were further investigated with DTPA scan. In patients with function of less than 10% on DTPA scan were subjected for nephrectomy.

Results: Of the total 72 patients of unilateral hydronephrosis enrolled, 50 (69.44%) were due to ureteric calculi, 18 (25%) were PUJ obstruction and 4 (5.56%) were renal calculi. Highest incidence was seen in third and fourth decade with Males to female ratio of 1.25:1. Commonest symptom was pain in abdomen followed by hematuria. Ureteric calculi of size less than 7 mm were given conservative trial and rests were managed surgically. Out of total 72 patients 43 patients were managed conservatively and rest 29 were treated surgically.

Conclusions: Ureteric calculus, pelviureteric junction obstruction and renal calculus were the etiological factors causing unilateral hydronephrosis and management was as per etiology.


Keywords


PUJ obstruction, Renal calculi, Unilateral hydronephrosis, Ureteric calculi

Full Text:

PDF

References


Walsh PC. Pathophysiology of urinary tract obstruction. In: Walsh PC, Vaughan R, Wein, editors. Campbell Urology. 8th ed. Philadelphia: WB Saunders Company; 2002: 412-440.

Fowler CG, The kidneys and ureters. In: Russell RCG, Williams NS, Bestrode CJK (eds). Bailey and love’s short practice of surgery, 24th ed. London: Arnold; 2004:1313-314.

Kim Hl, Belledegrum A. urology. In :Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JH, Pollock RE (eds). Schwartz‟s principles of surgery, 8th ed. New York, Mc Graw-Hill; 2005: 1545-547.

Arthur D, Smith MD. Surgical treatment of Hydronephrosis secondary to Uretropelvic junction obstruction. In: Seiman EJ, Hanno PM (eds). Current urologic therapy. 3rd ed. Philadelphia: WB Saunders Company; 1994: 34-35.

Ravi MC. Clinical study of hydronephrosis due Tourolithiasis (Doctoral dissertation). 2011.

Prasanna LC, Nataraj KM. Unilateral hydronephrosis-A clinical study. Inter J Curr Res Review. 2013;5(9):51.

Ingale AV, Gurav PD, Varshney G. Study of clinical profile of unilateral hydronephrosis. Indian J Med Res. 2015;5(11):2249-555.

Autorino R, De Sio M, Damiano R, Di Lorenzo G, Perdonà S, Russo A, et al. The use of tamsulosin in the medical treatment of ureteral calculi: where do we stand?. Urological Res. 2005;33(6):460-4.

Al-Ansari A, Al-Naimi A, Alobaidy A, Assadiq K, Azmi MD, Shokeir AA. Efficacy of tamsulosin in the management of lower ureteral stones: a randomized double-blind placebo-controlled study of 100 patients. Urol. 2010;75(1):4-7.

Pickard R, Starr K, MacLennan G, Lam T, Thomas R, Burr J, et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet. 2015;386(9991):341-9.

Pinter AB, Horwath A, Hrabovszky Z. The relationship of smooth muscle damage to age, severity of pre-operative hydronephrosis and post operative outcome in obstructive uropathies. Br J Urology. 1997;80(2):227-33.

O‟Reilly PH, Brooman PJC, Mak S, Jones M, Pickup C and Pollard AJ, et al. Studied the long term results of Anderson-Hynes pyeloplasty. B J Urology Inter. 2001;87:287-9.