What should I do about hydronephrosis?

Written by Zhou Qi
Nephrology
Updated on September 20, 2024
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Hydronephrosis is merely a consequence of urinary system diseases, indicating that the urine produced by the kidneys cannot be normally transported through the ureter to the bladder due to narrowing, adhesion, scarring, or obstruction somewhere. This causes the urine to accumulate in the renal pelvis and calyces. Therefore, the treatment of this disease requires identifying the cause, and then selecting a surgical treatment plan based on the situation. For instance, urinary system stones can cause hydronephrosis, and patients might need extracorporeal shock wave lithotripsy or open surgery for stone removal. Tumors in the urinary system can lead to hydronephrosis, and prostate hyperplasia can also cause similar symptoms, necessitating open surgery to resolve the obstruction. Some patients have congenital abnormalities, adhesions, or scars in the ureter, which might require surgical corrections of the ureter.

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Written by Li Liu Sheng
Nephrology
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Is hydronephrosis of both kidneys serious?

Clinically, bilateral hydronephrosis is serious, as it can lead to expansion of the renal pelvis. Long-term bilateral hydronephrosis can compress the renal parenchyma, leading to the development of chronic obstructive nephropathy, and thus cause chronic renal failure. Additionally, because urine cannot be expelled from the body in a timely manner in bilateral hydronephrosis, it is easy to combine with bacterial infections, which can lead to acute pyelonephritis. Patients may experience chills, fever, and severe back pain, as well as hematuria and general fatigue. Therefore, it is essential to identify the cause of bilateral hydronephrosis and treat it based on the nature of the hydronephrosis. Usually, the causes of bilateral hydronephrosis are related to stones, but tumorous diseases, bladder stones, or urethral strictures are also common causes.

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Written by Zhou Qi
Nephrology
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Does hydronephrosis hurt a lot?

Hydronephrosis does not necessarily cause severe pain. If the hydronephrosis develops suddenly over a short period, it might cause intense pain, most commonly due to urinary system stones blocking the ureter, leading to hydronephrosis. At this time, the ureter may experience spasms, causing severe pain. However, if the hydronephrosis develops gradually, the patient's pain symptoms might not be pronounced. For example, insufficient motility of the ureter or some type of narrowing could lead to the accumulation of fluid. If this condition develops slowly and persists for a long time, the patient might not feel particularly uncomfortable, despite the hydronephrosis, and it may only be discovered incidentally during a physical examination.

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Written by Chen Feng
Urology
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How to relieve pain from hydronephrosis

Hydronephrosis accompanied by pain is generally caused by kidney stones lodged in the ureter leading to renal colic, and the stones in the ureter can cause urinary obstruction, thus presenting as hydronephrosis. To alleviate the pain in such cases, treatment methods are chosen based on the size of the stone. If the kidney stone is relatively small and estimated to be able to pass by itself into the bladder, temporary use of pain relief medication can be administered for symptomatic treatment, along with medication that dilates the ureter to expand its diameter, facilitating the expulsion of the stone. If the stone is large and predicted not to pass on its own, temporary symptomatic treatment with pain relief medication can be used. Meanwhile, after completing preoperative examinations, surgery can be performed to remove the stone, which can also completely alleviate the pain symptoms.

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Written by Zhou Qi
Nephrology
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How is hydronephrosis diagnosed?

Strictly speaking, hydronephrosis cannot be considered an independent disease; it is merely a descriptive term in imaging, and is the result of many causes and various etiologies. It occurs because urine produced by the kidneys cannot smoothly pass through the ureters and bladder to be excreted from the body, leading to fluid accumulation in the renal pelvis and calyces. This may be caused by prostate enlargement, tumors in the urinary system, urinary system stones, or chronic inflammation and scarring of the ureters. Generally, hydronephrosis can be detected through imaging techniques, including urinary system ultrasound or CT, which can confirm the diagnosis.

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Written by Zhou Qi
Nephrology
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How is hydronephrosis treated?

The treatment of hydronephrosis often requires surgery. Decisions about diagnosis and treatment plans should be based on clinical symptoms, the duration of the obstruction, the location of the obstruction, and whether there is an infection. Since hydronephrosis is typically caused by a pathological factor that blocks the ureter, surgery is often necessary to remove the obstruction in order to address the hydronephrosis and prevent further damage to kidney function. The principle of the surgery is that if the obstruction is minor, a simple corrective surgery may suffice. However, if the dilation of the ureter and renal pelvis is very significant, a reanastomosis of the ureter and renal pelvis might be needed.