Hydronephrosis is an enlargement of the renal pelvis and calyces accompanied by atrophy of the renal tissue due to urinary tract obstruction. Urinary tract obstruction can occur anywhere in the urinary tract and may be unilateral or bilateral. The degree of obstruction may be complete or incomplete.
If there is a narrowing or obstruction of any part of the urinary tract and normal neuromuscular dysfunction, the passage of urine can be obstructed, resulting in urinary flow obstruction, and the pressure in the above part of the obstruction gradually increases due to poor urine discharge, and the lumen expands, which eventually leads to hydronephrosis, dilatation, thinning of renal parenchyma, and renal function decreases.
Clinical manifestations of hydronephrosis:
1, symptoms of the primary disease, such as stones with pain, tumors with hematuria, urethral stricture with difficulty in urination, etc.
2, fluid side of the waist swelling pain.
3.Complicated infection with chill, fever and pus urine.
4.Cystic lumbar mass on the affected side.
5.Bilateral obstruction with chronic renal insufficiency and uremia.
Auxiliary examination:
1, lumbar pain, lumbar cystic mass.
2.B ultrasound: kidney volume increased, cortical thinning, parenchymal liquid dark areas of different sizes.
3.X-ray intravenous urography showed hydronephrosis.
4.Isotope nephrography, obstructive nephrography.
5.Transureteral retrograde intubation angiography shows hydronephrosis
Treatment of hydronephrosis.
Treatment principles
1.Remove the cause of the disease and lift the obstruction.
2.The situation is too poor or the etiology is complicated can first percutaneous puncture nephrostomy Lou drainage of the kidney.
3, severe hydronephrosis or pus kidney, the opposite side of the kidney function is good then nephrectomy.
4, can not be surgically removed, put double “T” tube or stent tube.
5.The purpose of medication is mainly to prevent and control infection before and after surgery.
(I) Treatment goals
To remove obstruction, improve renal function, relieve symptoms, eliminate infection and repair normal anatomy as much as possible on the basis of elimination of etiology.
(II) Estimation of treatment
(i) Age: infants and children should be treated as early as possible, young adults can be appropriately observed, and timely surgery should be performed if there is progress, and early consideration of surgical treatment to preserve sound renal function is advisable over 50-60 years of age.
②Estimation of renal function and obstruction.
a. At least 1/5 of normal renal tissue should be preserved to maintain the minimum function of life. If not necessary, try not to make renal drainage to prevent the development of infection.
b. For patients with asymptomatic hydronephrosis without infection, they can be reviewed and observed with ultrasound, CT and intravenous pyelogram every 6 to 12 months, and if there is no progress, surgery can be suspended.
c. Obstruction at the pelvic-ureteral junction may cause stones, therefore, while removing the stones, the presence of stone forming etiology must be explored. If there is stenosis, it should be corrected at the same time.
③Estimation of intrarenal versus extrarenal pelvis surgery: Intrarenal type pelvis is more difficult to handle.
④ Timing of surgery for bilateral hydronephrosis: In bilateral hydronephrosis without infection, the poorly functioning side can be treated first so that the contralateral side continues to be under compensatory hypertrophy of the functional load. The kidney on the side of the plastic surgery recovers better under certain stimulation. For those with infection, it is appropriate to choose the severe side to operate first, and should be made as soon as possible on the opposite side. If the infection is only on the side with better function, surgery should be given priority to maximize preservation of kidney function and control infection, and surgery on the other side should be considered after stabilization of the disease.
In one of the better functioning kidneys with hydronephrosis, but still plastic surgery can be done to try to salvage the kidney function, surgery should be considered first. If the kidney on the opposite side has been destroyed and is non-functional, it is necessary to wait until the kidney on the operated side has recovered its function and the condition has stabilized before deciding whether to perform immediate amputation.
(iii) Treatment modalities.
1.Local treatment: For the lesion at the obstruction site, local treatment can be used to solve the problem, such as adhesion separation, fiber band cutting, vessel displacement and reanastomosis, stone removal, etc. If the local compression is too long and has caused serious damage to the local development of ureter, this section of ureter should be removed and reanastomosed.
2, for obstruction has caused serious water in the kidney, need to make a fistula drainage first.
3.Plastic surgery: The main points of plastic surgery must be mastered.
①Make the pelvic ureteral anastomosis at the lowest point of the renal pelvis.
②The pelvic ureteral anastomosis should be funnel-shaped.
③The repair should remove the surrounding fibers, adhesions, and scar tissue, but do not damage the blood supply.
④Remove the excess renal pelvic wall and maintain a certain pelvic tension. If the hydronephrosis is too large, the thinner renal cortex can be folded inward and then fixed to reduce the renal volume.
⑤ To reduce anastomotic leakage, a double pigtail catheter can be placed. To avoid the formation of scarring fibrosis around the anastomosis due to urine leakage and hemolysis depression, a negative pressure suction tube can be placed outside the anastomosis for adequate drainage.
(6) There are many plastic surgery options, but currently it is considered that excision of the diseased segment and then anastomosis is preferable from an etiopathological point of view.
Dietary care
①Increase energy intake, but in order to avoid increasing the burden on the hydronephrosis kidneys, it is not advisable to eat too much protein-rich food. Energy intake is mainly based on carbohydrates and fatty foods.
②If there is unilateral hydronephrosis, it is not necessary to limit the amount of water intake. If there is bilateral hydronephrosis with renal dysfunction, it is necessary to limit the daily water intake.