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 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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Nephrology
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What is hydronephrosis?

The so-called hydronephrosis is a morphological description, referring to an obstruction in the urinary system caused by various reasons. After the kidneys produce urine, it cannot be normally delivered to the bladder. This leads to fluid accumulation in the renal pelvis and calyces, which can be detected through imaging as hydronephrosis. The causes of hydronephrosis are numerous. The most common cause is acquired obstruction, primarily due to urinary system stones, scarring from injuries, or tumors in the urinary system compressing the ureter, which often results in urinary tract obstruction. In addition, some congenital causes can also lead to urinary tract obstruction. Examples include segmental dysfunction of the ureter, intrinsic stenosis of the ureter, and twisting of the ureter. However, these congenital obstruction causes are relatively rare.

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Nephrology
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What is the best treatment for hydronephrosis?

The so-called hydronephrosis often occurs due to some factor blocking the urinary system, causing urine to not be excreted normally. The most common cause is urinary system stones, but it can also be due to issues like tumors or benign prostatic hyperplasia. The treatment for stones depends on the size of the stone. Stones smaller than 5 millimeters in diameter can often pass naturally. If the stone is 7 to 15 millimeters in diameter, extracorporeal shock wave lithotripsy is typically used. If stones in the lower mid-ureter do not respond well to medication, retrograde removal under cystoscopy can also be performed. For some patients who have had a long-standing obstruction, renal function may already be impaired. If the obstruction cannot be relieved, surgeries such as creating a urinary diversion can be performed. This includes procedures like bladder fistulation, pyelostomy, or percutaneous ureterostomy, among others.

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What are the symptoms of hydronephrosis?

Hydronephrosis is often due to obstructive factors in the urinary system, such as stones, tumors, prostate hyperplasia, etc., causing urine to not be excreted smoothly, so patients may have symptoms related to obstructive kidney disease. Since the kidney is in a state of water accumulation, the ureter may experience spasms, so patients may experience pain in the lower back area. Especially in patients with kidney stones leading to hydronephrosis, as these kidney stones can cause severe pain. Furthermore, patients may experience hematuria. If the hydronephrosis is bilateral, it can lead to a sudden decrease in urine output and acute renal failure.

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Is hydronephrosis scary?

Hydronephrosis is rather alarming, as it harms the body in two main ways: First, it creates increased pressure inside the kidneys due to fluid accumulation in the urinary system. This pressure can compress kidney tissue, and if not resolved, may lead to irreversible kidney damage and renal failure. However, if hydronephrosis formed in the short term is quickly addressed by clearing the urinary system, it typically has minimal impact on kidney function. Another aspect relates to the causes of hydronephrosis, some of which are complicated issues, such as bladder cancer, rectal cancer, or cervical cancer in females. These cancers can press on the ureter, leading to hydronephrosis. Other causes, such as urolithiasis or benign prostatic hyperplasia, are relatively easier to manage.