What is hydronephrosis?

Written by Zhou Qi
Nephrology
Updated on September 10, 2024
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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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Written by Zhou Qi
Nephrology
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Hydronephrosis should see which department?

Hydronephrosis should be treated at a formal hospital's department of urology. Hydronephrosis is due to some factor causing urinary tract obstruction, potentially seen in urological conditions such as stones, tumors, congenital abnormalities of the ureter, and other causes. These lead to the kidney producing urine that cannot be properly expelled. Dealing with this condition often requires intervention by the urology department, as hydronephrosis typically necessitates surgery. In early stages, patients may need to adopt corresponding methods to address the specific causes. For instance, patients with stones might need extracorporeal shock wave lithotripsy, and open surgery might also be necessary; deformities of the ureter might need corrective surgery. These surgical treatments need to be performed in the urology department.

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Written by Zhou Qi
Nephrology
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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.

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Nephrology
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How is hydronephrosis caused?

The causes of hydronephrosis can be divided into congenital, acquired, and external factors. Among these, acquired causes are the most common, primarily referring to obstructions in the urinary tract, such as stones that block the ureter, leading to hydronephrosis, inflammation, or ischemic damage. Scarring of the ureter can also result in hydronephrosis. Tumors or polyps in the renal pelvis and ureter may also cause obstructions leading to fluid accumulation. External causes mainly include diseases of retroperitoneal organs, such as abscesses, bleeding, tumors in the retroperitoneum, and pelvic tumors, like rectal cancer. Congenital causes mainly involve intrinsic narrowing of the ureter, ectopic vessels causing compression, and high insertion of the ureter, which are less common.

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Written by Zhou Qi
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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Will hydronephrosis cause facial swelling?

In cases of hydronephrosis, it is not certain whether facial swelling will occur. Since the human body has two kidneys, the kidneys have strong compensatory capabilities. Even if one kidney is completely damaged, if the other kidney remains healthy, the remaining kidney can still perform the function of two kidneys. It can ensure sufficient excretion of water and metabolic waste. When water is sufficiently excreted, swelling should not occur. However, if both kidneys are affected by hydronephrosis, or if the opposite kidney also has problems, then the ability of the kidneys to excrete water may decrease. With both kidneys having issues, it can lead to poor and insufficient water excretion, consequently causing swelling, such as bilateral eyelids, facial areas, and both ankles.