What is the best treatment for kidney hydronephrosis. Hydronephrotic transformation of the kidney or hydronephrosis: causes, symptoms and treatment. Diet therapy and preventive measures for hydronephrosis

Afer Dima

Hydronephrosis of the kidney: symptoms and treatment depending on the stage

Hydronephrosis of the kidney is specific disease, characterized pathological increase internal size of the renal collecting region due to strong pressure a large volume of fluid (urine excreted by the kidneys) onto its walls. In this case, the accumulation and stagnation of urine is associated with a complete or partial disruption of its outflow through the urinary system. This leads to inflammation of the renal tissue - parenchyma, followed by its atrophy and deterioration of the filtering and excretory function of the kidney. As a result of this, partial, and then, as the disease progresses, complete renal failure may occur.

To prevent poisoning of the body by waste products, in such cases it is recommended to remove one, and when there is bilateral hydronephrosis, both damaged kidneys. In the future, such patients are advised to undergo regular hemodialysis sessions on the machine. artificial kidney or a donor organ transplant.

Depending on the causes of the development of the disease, its forms are distinguished:

• Congenital – hydronephrosis develops in utero or immediately after birth.
• Acquired – hydronephrosis appears as a result of damage to a previously healthy kidney.

Let us highlight the main degrees of hydronephrosis or, as they say, stages:

• Stage I - there is an expansion of only the pelvic system without disruption of the functions of the organ.
• Stage II – significant expansion of the pelvis, accompanied by thinning of its walls and impaired renal function up to 20%.
• Stage III - the kidney is represented by a large multi-chamber cavity filled with urine. Functions are reduced to less than 80%.

Causes of occurrence and development of hydronephrosis

Congenital or acquired form of hydronephrosis of the right or left kidney can occur as a result of deterioration or complete cessation of the movement of urine from the pelvic region through the ureter to the bladder and urethra. The causes of this disorder can be both anatomical and physiological factors.

Congenital hydronephrosis in children manifests itself as a result of existing defects in the shape and structure of the kidney, ureter and lower urinary system. Also, congenital or acquired hydronephrosis of the kidney in children can occur due to developmental pathology blood vessels during the prenatal period or the first year of life. Congenital causes:

• Pathological narrowing of the internal lumen (dysthenesia) of the urinary tract at the level of the kidney, ureter, bladder sphincters or urethra.
• A congenital anomaly of the renal artery itself or its branch, in which the vessel has the shape of a ring that compresses the ureter and prevents the normal outflow of urine.
• Abnormal shape, kinking, or malposition of the ureter.
• Congenital developmental pathology lower sections urinary tract (obstruction; ureterocele, etc.).
• Immaturity or underdevelopment of the urinary system in premature infants.

The acquired form of hydronephrosis may have both anatomical causes of impaired urine outflow from renal pelvis, and physiological (arising against the background of diseases of the central and peripheral nervous system). In total, there are five main groups of pathological conditions that create mechanical obstacles of an anatomical nature in the urinary system:

• Thickening of the walls of the ureter or pelvis as a result of tumors.
• The presence of tumors in surrounding organs and tissues that compress the ureter, kidney or urethra.
• Violation of the normal location of the ureter or kidney (prolapse of the kidney, bending or torsion of the ureter).
• Blocking of the internal lumen of the ureter and pelvis with formed kidney stones.
• Compression or damage to the lower organs of the urinary system as a result of cancer and other diseases or injuries.

Quite often, women experience hydronephrosis during pregnancy. Its cause is mechanical compression of the ureter and other organs of the urinary system by the enlarged uterus.

Hydronephrosis, uncomplicated in the first stages of development, has virtually no symptoms and clinical manifestations. The patient feels only a slight deterioration in health, increased fatigue. Therefore, it is possible to suspect mild degrees of hydronephrosis at this stage only with a random examination for other diseases. An enlarged renal pelvis can be determined, for example, by palpation or diagnostic ultrasound.

If associated inflammatory diseases, one can already suspect unilateral or bilateral hydronephrosis based on the following symptoms, which are also characteristic of other kidney diseases:

• Constant or periodic aching pain in the lumbar region.
• Frequent or severe renal colic.
• Nausea, vomiting, bloating and increased blood pressure during attacks of renal colic.
• Initially, a decrease and then a significant increase in the amount of urine during urination.
• A tumor-like formation palpable on palpation in the area of ​​the right or left hypochondrium (or on both sides).
• The appearance of blood in the urine (at the same time its color becomes brownish or reddish).

For more late stages As the disease progresses, the symptoms of kidney hydronephrosis become more obvious.

Methods for diagnosing hydronephrosis

Hydronephrosis that develops latently and does not have relapses may not have symptoms of inflammation or obvious impairment of filtering and excretory functions. This can continue until the development of the initial form renal failure. Therefore, if the amount of urine decreases or its color and concentration changes, it is urgent to conduct a comprehensive laboratory and hardware examination by a urologist.

To the most precise methods Diagnosis of hydronephrosis includes:

• Laboratory research: general blood and urine analysis, biochemical blood tests, urine analysis according to Zimnitsky, Nechiporenko and others.
• Ultrasound examination of both kidneys, ureter and bladder, which, if necessary, is supplemented by examination of other internal organs.
• X-ray examination of these organs using contrast agents.
• Hardware magnetic resonance imaging (MRI).

Hardware diagnostic methods help determine and compare on which side kidney damage is present or predominant. So hydronephrosis right kidney has a larger pelvic area compared to a healthy left kidney. Or vice versa, hydronephrosis of the left kidney has a larger pelvis compared to the right kidney.

Treatment of kidney hydronephrosis

Once the diagnosis is confirmed, treatment for kidney hydronephrosis should begin immediately. After all, when further development and complications of this disease, the prognosis for the patient can be extremely unfavorable. And effective therapeutic techniques There are currently no treatments that can completely restore kidney function.

Drug treatment of hydronephrosis for patients with unilateral or bilateral kidney damage can only be carried out as a symptomatic therapy or in preparation for surgical treatment.

Surgery for kidney hydronephrosis can either completely eliminate or only reduce the manifestation of this disease. Result and forecast surgical treatment largely depends on the form and stage of the disease. With complete elimination anatomical reasons compression of the kidney or ureter, as well as minor violation its functions, it is possible to completely get rid of hydronephrosis.
Timely surgical treatment is especially important for eliminating congenital hydronephrosis in children. In most cases, operations performed to eliminate defects or plastic surgery of congenital pathologies of the kidneys and ureter give good results and a favorable prognosis for the life and health of the child.

Treatment and dietary nutrition for hydronephrosis in pregnant women

Treatment of hydronephrosis during pregnancy is aimed at restoring the outflow of urine from the kidneys with the help of special physical and breathing exercises, physiotherapeutic procedures, laxatives, long walks in the fresh air and dietary nutrition. The main goal of such therapy is the prevention of inflammatory diseases genitourinary area. Only with very severe forms For this disease, termination of pregnancy is recommended.

Specially designed therapeutic diet for hydronephrosis of the kidney in pregnant women and children, includes dishes with a high fiber content: black bread, a variety of boiled or steamed vegetables, lean boiled fish and veal, beetroot soup, cabbage soup and borscht with beets, etc. But you should avoid fatty, fried and salty foods.

Forecast and prevention of the disease

Timely elimination of the causes of hydronephrosis contributes to rapid recovery all kidney functions. If the obstruction lasts a long time and is accompanied by bilateral damage or infection, then in this case the prognosis for the disease is serious and often ends with the need for hemodialysis or a donor kidney transplant.

In order to prevent the development of hydronephrosis, regular medical examination with ultrasound examination of the kidneys and laboratory analysis of urine.

Men who have been diagnosed with renal hydronephrosis during examination are interested in finding out what it is and what the outcome of the disease may be. In medicine, this pathology is also called hydronephrotic transformation, that is, a condition in which, due to a violation of the outflow of urine, the calyces and pelvis of the kidneys expand, which leads to an increase in hydrostatic pressure in them.

In this article you will learn what signs accompany the pathology, how to treat renal hydronephrosis modern methods, what else can be done. You will be able to see photo and video materials on the topic.

Causes and stages of development of the disease

The factor that provokes the development of kidney hydronephrosis is an obstacle to the natural outflow of urine from the organ. This may be due to any pathological process occurring both in the kidney and outside it - in nearby organs and tissues:

• stricture (narrowing) urinary tract, congenital or acquired;
• various stones in the genitourinary system;
• benign neoplasms;
• malignant tumors;
• retroperitoneal fibrosis.

As a result of urinary retention and expansion of the calyces and pelvis of the kidney, the parenchyma and muscle fibers organs atrophy. This leads to deterioration of kidney function, up to complete loss of function.

In total, doctors distinguish three stages of pathology development, each of which is characterized by changes in the size of the organ and a deterioration in its functioning.

1. A slight accumulation of urine causes a slight enlargement of the pelvis. In this case, the function of the organ is not impaired or slight deterioration occurs.
2. The affected kidney enlarges by 20%, while its walls become thinner, and its performance decreases by 40%. At this stage, the healthy kidney “takes over” the load, which to some extent compensates for the failure.
3. The kidney increases in size by one and a half or two times. The pelvis and calyxes expand, internal cavity has a multi-chamber structure. The outflow of urine is disrupted, the kidney practically does not function, or does not work at all. As a result, the load on the healthy kidney increases and the organ ceases to cope with its function. The third stage of hydronephrosis, called terminal, is accompanied by chronic renal failure. If there is no treatment, the outcome of the disease is fatal.

In addition to classification according to the stage of development of pathology, in medicine pathology is designated by four degrees, depending on the condition of the parenchyma.

1. The kidney parenchyma is unchanged.
2. Minor structural damage.
3. Significant violation.
4. Absence, complete atrophy of the parenchyma of the damaged kidney.

Hydronephrosis develops with equal frequency in both the left and right kidneys. In some cases, two kidneys are damaged at once. This condition is called bilateral renal hydronephrosis.

Symptoms of the disease

At the first stage, hydronephrosis occurs without pronounced symptoms and is often discovered by chance when examining a patient in connection with various complaints. At this stage, the symptoms directly depend on the causes of the pathology. For example, if hydronephrosis occurs as a result of stone formation, then accompanying symptom there will be a sharp, acute pain along the ureters.

As the pathology progresses, the patient complains of the following problems:

• dull pain in the lower back, independent of the time of day and body position;
• painful sensations are most pronounced in the area of ​​the affected kidney: if it hurts left side lower back, then affected left kidney and vice versa;
• in some cases, pain appears in the right side of the abdomen;
• often painful sensations are accompanied by nausea and vomiting.

The patient may experience increased blood pressure and bloating. When an organ becomes infected, the body temperature rises. In some cases, the only symptom of hydronephrosis of the left or right kidney is the presence of blood particles in the urine. This situation is possible if the problem is caused by the development of urolithiasis. Stones leaving the bladder injure the walls of the ureters and impede the outflow of urine.

Read also: Kidney pain: how to treat it, what medications to use

On last stage signs of chronic renal failure appear, edema develops, blood pressure rises and anemia. The patient should definitely seek help from a doctor if lower back pain begins. Hoping for self-medication, the patient misses favorable time to start treatment. The outcome in this case can be disastrous: from removal of the affected kidney to death.

Diagnosis of pathology in a medical facility

It is impossible to make any diagnosis, including “grade 2 hydronephrosis of the right kidney,” based only on symptoms. The doctor must refer the patient for a comprehensive examination to rule out other diseases and determine the cause of the pathology.

First, the doctor collects anamnesis and conducts an external examination of the patient. The presence of a slight swelling in the lumbar region, a violation of symmetry in this area and the detection of a space-occupying formation on palpation give reason to suspect the development of renal hydronephrosis. To confirm or refute the preliminary conclusion of the doctor, an instrumental examination is necessary.

In modern medicine, the diagnosis is made based on the results of the following types of examinations:

• Ultrasound of the kidneys - will reveal an enlargement of the renal pelvis, changes in the size of the kidney and the thickness of the parenchymal layer;
• X-ray examination - it can be used to detect stones, the nature of damage to the urinary tract, the size of the kidney and other parameters;
• radioisotope urogrophy – to make a more accurate diagnosis.

In some cases, if the results of previous examinations are equivocal, the patient may be referred for an MRI or CT scan.

In addition to instrumental examination, it will be necessary to take urine and blood samples for microscopic examination. Having the results of examinations and tests in hand, the doctor can determine the pathology and identify the problem that caused the formation of hydronephrosis of the left or right kidney.

Treatment methods for hydronephrosis

The course of treatment that the doctor will select has three directions: relieving symptoms, eliminating the cause and reducing the load on the kidneys. The following measures are effective for this:

• conservative therapy - the use of drugs that help eliminate the disease and alleviate the patient’s health condition;
• surgical intervention - operations aimed at restoring the kidney or removing it;
• adjusting the patient’s lifestyle – diet and other restrictions.

Let us consider each measure to combat renal hydronephrosis in more detail.

Drug treatment

Often application medicines precedes the operation. At this stage, the symptoms of hydronephrosis are eliminated, urination is stimulated, and side effects are removed. pathological processes, for example, foci of infection.

The doctor may prescribe the following medications:

• painkillers - for relief painful sensations in the patient;
• antibiotics – if there are signs of infection in the body;
• drugs that lower blood pressure;
• anti-inflammatory drugs;
• other medications, depending on the patient's symptoms.

It should be remembered that drug treatment It is used only in the first and second stages and often does not eliminate the pathology. Therefore, surgery today is the only effective method of combating pathology.

Surgeries for hydronephrosis of the kidneys

Surgical intervention in the first stages of the development of hydronephrosis is aimed at preserving the affected kidney. If necessary, restored urinary tract, plastic surgery of the renal pelvis is performed. Surgical treatment of hydronephrosis of the right kidney is particularly difficult: there is a high probability of damage to the pancreas.

If you are interested in methods of performing operations, see the table.

After the operation, the recovery period lasts a week to a week and a half, depending on the method of surgical intervention chosen by the doctor. The patient is in the hospital, under observation medical specialists. During this period, anti-inflammatory drugs are prescribed and general restorative therapy is carried out. Spicy and salty foods are excluded from the patient's diet.

After surgery to remove a kidney, it is advisable to adhere to following rules power supply:

• remove fatty, spicy and salty foods;
• increase daily consumption fresh vegetables and fruits;
• drink two liters of liquids a day, give up alcohol and smoking.

As for physical activity, you need to follow your doctor's instructions. Typically, limiting physical activity is important for a month after the operation. In some cases, especially if the intervention was performed laparoscopically, this period may be reduced.

Diet for kidney hydronephrosis

The main task of adjusting the diet for renal hydronephrosis is to reduce the load on the affected organ. For this, diet No. 7 according to Pevzner, enriched with vitamins and limiting the intake of fat and protein, is effective. With this diet, the diet may include:

• baked goods yeast dough without salt;
• cereal or vegetable soups;
• egg yolk;
• whole milk and dairy products (sour cream, yogurt);
• oils, including ghee and butter;
• cereals and any pasta;
• fresh vegetables and herbs;
• fruits and berries in any form;
• compotes and jelly;
• sugar or honey;
• weak tea;
• natural juices;
• rosehip decoction.

Dishes are prepared without salt; frying without breading is allowed. The preferred method of cooking is boiling. Baking possible. Heavily fried foods are prohibited for hydronephrosis.

The patient should exclude from the diet:

• regular bread and others flour products, especially if soda is present in the recipe;
• legumes in any form;
• meat, fish and mushroom broths;
• any meat and fish;
• cottage cheese and cheese;
• animal fats;
• pickled, salted or pickled vegetables and mushrooms;
• sweets.

It is forbidden to drink strong tea and coffee, alcohol and mineral water.

Meals are fractional, meals 5-6 times a day, in small portions. This diet is prescribed for a week, then the doctor can adjust the diet: exclude or, conversely, introduce some dishes and products into the diet.

Conclusion

You should not be afraid of the diagnosis of hydronephrosis of the left or right kidney. The level of development of modern medicine makes it possible to cope with the disease even at the last, third stage. To find out how to treat kidney hydronephrosis, you need to consult a doctor at the first symptoms. Compliance with the doctor’s recommendations, timely surgery, lifestyle adjustments will help cope with the pathology and restore usual quality life.

Hydronephrotic transformation of the kidney or renal hydronephrosis is a serious pathology consisting in increased content fluid in both or one kidney. In other words, according to various reasons the normal flow of urine is disrupted. If treatment for hydronephrosis is not started promptly, the kidney may fail and there will be a serious risk to the patient's life.

Classification, types, degrees of severity

Experts divide hydronephrosis of the kidneys into types according to various signs. Among urologists, the classification according to ICD 10 is accepted (this is an abbreviation of the international classifier of diseases, which is also accepted in Russia and is updated every 10 years).

According to this classification, kidney hydronephrosis is primarily divided into congenital and acquired ailments. Thus, a disease initiated during the prenatal period is assigned code Q62.0 according to ICD 10.

Code No. 13 according to ICD 10 has renal hydronephrosis with dysfunction of the junction of the pelvis and ureter. There are also hydronephrosis of the left kidney and hydronephrosis of the right kidney with narrowing of the ureter. This is No. 13.1.

And hydronephrosis numbered 13.2 is an ailment that arose as a result of urolithiasis.

Congenital hydronephrosis can occur both as a result of disturbances in the development of the fetus at the intrauterine stage, and due to various chromosomal abnormalities. However, hereditary factor can lead to the development of this disease at any age. Acquired hydronephrosis also develops as a complication after a number of diseases and as a result of other pathogenic factors. It has been noted that between the ages of 20 and 60, the disease more often affects women; in old age, men are more affected, on the contrary.

And yet such a division - into primary and secondary - cannot be called complete. Pathology is also classified according to other criteria. Thus, they distinguish both hydronephrotic transformation of two kidneys and one - hydronephrosis of the right kidney or the left. Bilateral hydronephrosis is a fairly rare phenomenon; it is observed in no more than 9% of all cases of the disease.

Urologists distinguish between hydronephrosis and the degree of the disease. It can be acute or chronic. If the patient has acute hydronephrosis, treatment started on time can lead to the restoration of full kidney function. IN chronic stage Some kidney functions are lost forever. And yet, with proper treatment, it is possible to provide the patient normal quality life.

Hydronephrosis is also classified according to the type of development. If the disease is complicated by an associated infection, then it proceeds according to the infected type. If not, such a disease proceeds aseptically, the symptoms in these two cases will be slightly different.

It should be noted that hydronephrosis has several degrees of severity:

1. Hydronephrosis 1st degree. It can proceed quite easily. The patient sometimes does not notice the symptoms or they are not very pronounced. However, the renal pelvis (or pelvis) is already slightly stretched, the kidney is enlarged, although it still serves its purpose. At this stage, a little more than 10 ml of liquid accumulates in it.
2. Hydronephrosis 2nd degree. It is characterized by further expansion of both the renal calyces and the pelvis. The tissues become thinner under the pressure of excess fluid, the kidney atrophies and copes with its functions much worse. However, it is still possible to correct the situation by tracking the symptoms in time.
3. Hydronephrosis grade 3. It is considered irreversible. As a result of such advanced pathology, kidney death inevitably occurs.

Causes of hydronephrosis

Congenital hydronephrosis appears due to various reasons, including the following:

• presence of urinary tract dyskinesia;
• abnormal location of the kidney arteries, which put pressure on the ureter;
• incorrect position of the ureter in relation to the vena cava (posteriorly);
• congenital structures, urinary tract obstruction, ureteric valves.

Acquired hydronephrosis can develop if there is various diseases urological nature. Moreover, the causes of hydronephrosis in men and women are usually different.

Thus, in representatives of the stronger sex, hydronephrosis most often occurs as a result of:

• prostate tumors are usually benign;
• prostate cancer.

Women, as a rule, suffer from hydronephrosis as a result of:

• pressure of the uterus enlarged during pregnancy on the ureters;
• cancer of the uterus, ovaries or cervix (tumor presses on the ureters);
• malignant tumor of the kidney or bladder.

There are also causes of hydronephrosis that are much less common:

One of the main signs of hydronephrosis is that the patency of the urinary tract is impaired. It occurs as a result of anatomical obstacles. They are divided into 5 different groups:

• located in the urethra or bladder;
• located at the same level as the ureter (not in its lumen);
• caused by kinking of the ureters or their incorrect position;
• located in the lumens of the renal pelvis or ureter;
• localized in the walls of the pelvis or ureter.

Symptoms of pathology

As mentioned above, hydronephrosis is dangerous due to the fact that its symptoms are initial stage(in the so-called first period) are not expressed. Experienced doctors carefully collect anamnesis, including specifying how the patient sleeps. Often with hydronephrosis, the patient prefers to sleep on his stomach - this makes it easier for fluid to drain out.

It is especially difficult to identify hydronephrosis in children - it happens that symptoms do not appear either at the first or even at the second stage. The difficulty of diagnosis also lies in the fact that the disease manifests itself differently depending not only on the stage, but also on the type of pathology, its nature, and course.

So, for example, acute hydronephrosis is characterized by the following symptoms:

• severe pain in the side or back;
• nausea and vomiting;
• increased pain after drinking liquids;
• manifestation of pain on the side where the kidney is affected (or on both sides, if both are affected);
• sometimes the pain goes to the vagina (women) or testicles (men);
• if the urine is infected, fever and chills develop;
• if there are kidney stones, there may be blood in the urine;
• V severe cases the kidneys are enlarged, this can be determined by touch.

In the case of chronic hydronephrosis, symptoms may be as follows:

• the same as for acute;
• do not appear at all;
• back pain that comes and goes;
• urination is rare compared to usual.

If we talk about the symptoms of unilateral hydronephrosis, then they include: constant fatigue, discomfort in the lumbar region, turning over time into aching pain, increasing with increasing physical activity or taking significant amounts of fluid. There is also a clear decrease in performance and swelling.

Sometimes the patient's blood pressure increases. If the outflow of urine is seriously impaired, the person feels nauseous and even vomits, the pain becomes paroxysmal, as with renal colic, and blood appears in the urine. Then speech it's already underway about the second period of development of hydronephrosis, when clinical picture clear. At this stage, dyspepsia often occurs, which sometimes interferes with correct diagnosis hydronephrosis, especially in young children.

Symptoms with bilateral hydronephrosis are more obvious, because kidney dysfunction increases, azothermia occurs, that is, an increase in the amount of nitrogen in the blood. This threatens kidney failure.

If the disease is complicated by an infection, purulent pyelonephritis has developed (this happens), chills and fever occur.

Diagnosis of the disease

The doctor prescribes treatment for kidney hydronephrosis only after accurate diagnosis. To do this it is necessary to carry out full examination. During the physical examination (i.e. palpation, auscultation and percussion) little can be learned, so after initial examination and taking an anamnesis, a number of studies are usually prescribed.

There are also many additional methods, with the help of which pathology is detected. But they are not that common. The appropriateness of using one or another individually or many in combination is determined by the attending physician.

Treatment methods for hydronephrotic transformation

The goal of treatment for hydronephrosis is to:

• remove accumulated urine and reduce the pressure it puts on the kidneys;
• prevent irreversible deformation;
• eliminate the cause that caused hydronephrosis.

Usually, with severe hydronephrosis, conservative therapy is ineffective, therefore it is used only at the initial stage of the disease and is symptomatic. That is, the patient is given painkillers, anti-inflammatory drugs, lowers blood pressure, fights bacteria with the help of antibiotics in case of infection, etc. In addition, in the presence of urolithiasis (UKD), oral alkalizing therapy is prescribed, and in case of retroperitoneal fibrosis, steroids are prescribed.

It is believed that in young children, especially under one year of age, the disease in the initial stages can go away after the symptoms have been relieved. Therefore, doctors rarely immediately prescribe surgery for a child with hydronephrosis. Usually the baby is observed for a year; often the disease does not require surgical intervention and disappears on its own. Urgent surgery is indicated only in the third stage of hydronephrosis in children.

Adults, as a rule, after relief of symptoms, begin to prepare for surgical intervention. And usually the doctor uses a combination of different methods.

Urine diversion

It must be carried out both when the patient is being prepared for surgery, and if for now they have decided to do without it. A catheter is inserted into the bladder to drain fluid, thereby reducing pressure on the kidneys.

Surgery

Treatment of the cause begins when the pressure on the kidneys eases. The doctor will usually remove the cause of the fluid blockage. For example, if the ureter is blocked, a stent is placed in it - a thin tube that allows urine to bypass the blocked area.

The urological surgeon then begins to treat the underlying cause of hydronephrosis. Eg:

• kidney stones are broken up with a laser or ultrasound;
• the prostate tumor is removed, often including part of the gland itself or the entire prostate;
• Malignant tumors are treated with removal, chemotherapy, and radiation therapy.

In a word, the main essence of the operation is to get rid of the cause of hydronephrosis. The surgeon removes the obstacle that disrupts the physiological outflow of urine, in some cases performs plastic surgery of the pelvis, restoring its size.

The attending physician chooses the surgical method depending on the severity of the disease, its stage, taking into account all the circumstances. Nowadays doctors often use abdominal operations, and more gentle methods are endoscopic. The surgeon makes only two small punctures, inserts an endoscope and monitors the progress of the operation on the monitor.

This method is bloodless, low-traumatic, and poses almost no threat. postoperative complications. However, if the pelvis is too large or there are other problems, endoscopy is not indicated; it is ineffective.

Hydronephrosis can also be treated using laparoscopy - this is also low-traumatic method, which, at the same time, allows for resection of the pathological area of ​​the ureter.

In cases where hydronephrosis is advanced and has entered the third stage, the so-called thermal stage, the kidney almost inevitably dies and must be urgently removed. This operation is called nephrectomy; it is more expedient to do it at a later stage. early stage when the kidney has not yet failed and the inflammatory process has not begun. Practice shows that most often elderly patients undergo nephrectomy.

Drug treatment

As in most cases, you need to remember about vitamins, and especially vitamin C. True, it is generally accepted that it is found in abundance in lemons, however, as a rule, it is stored in fruits for no more than 2 months after collection, after what is destroyed. Cherries and black currants are much better suited, since even when frozen they can retain this valuable vitamin. In addition, these fruits contain about 10 times more vitamin C than lemons. You can also take tableted vitamins, such as Ascorutin.

To strengthen the kidney vessels, doctors recommend eating foods rich in L-arginine. It is an amino acid that is rich in e.g. pumpkin seeds, walnuts and Pine nuts. However, to replenish it in the body, you will need to eat almost a kilogram of nuts or seeds per day, which is certainly impossible. Experts recommend using in this case special drug, which is called “L-Arginine”. You can also take Trental instead.

If the patient has experienced surges in blood pressure during the course of the disease, in no case should it be immediately cancelled. antihypertensive drugs and take them in small doses for another six months. This will prevent the formation of ischemia in the kidneys. In addition, your doctor may prescribe course treatment the following drugs: “Canephron”, “Cyston”, “Rovatinex”.

Diet and proper nutrition

For each case of hydronephrosis, the diet will be special depending on the degree of the disease, its nature and the cause of the disease. The attending physician decides which diet to prescribe for hydronephrosis. But there are a few general rules:

• liquid should be consumed moderately, no more than 2 liters per day;
• reduce salt consumption in the diet - no more than 2 g per day, or better yet, remove it from the menu altogether;
• you should eat more vegetables, especially fresh ones;
• remove legumes, fatty meat, coffee, chocolate, sausage, everything smoked, and sea fish from your diet.

Summary: Hydronephrosis is a disease characterized by swelling of the kidneys and disruption of the normal flow of urine from them to the bladder. Hydroureter is swelling of the canal connecting the kidney and bladder (ureter). Obstruction is a blockage, obstruction. It can occur in any part of the ureter, at any level.

Hydronephrosis can be unilateral (only one kidney is affected) or bilateral (both kidneys are affected). The disease can cause high blood pressure. If it is not lowered in a timely manner, kidney function will be compromised. Symptoms of hydronephrotic transformation vary depending on whether swelling occurs immediately or gradually. In acute cases, the patient experiences severe pain, he feels sick and vomits.

Treatment of hydronephrosis and hydroureter is aimed at restoring the flow of urine from the diseased kidney.

Prevention measures

Because the special measures There is no way to prevent this disease; it is necessary to prevent the possibility of the occurrence and formation of any inflammatory processes. To do this you need:

• visit a urologist at least a couple of times a year;
• monitor nutrition healthy image living with regular physical activity, limiting the intake of salt and salty foods;
• prevent hypothermia of the body;
• promptly treat any emerging genitourinary system infections.

Hydronephrosis is pathological condition, in which a violation of urine drainage from the kidneys leads to an increase in pressure in the lumen of the collecting system (calyx, pelvis) and its expansion. Likewise, the ureter may dilate, a condition called hydroureter.

The incidence of pathology among people is 3.1%. In adults aged 20-40 years, it is slightly lower - about 1%.

Show all

1. Prevalence

1. 1 In 1 in 800 children, ultrasound during pregnancy shows signs of renal hydronephrosis. Before birth, the frequency of detection of pathology in the fetus is 1 in 1500 examinations. After birth, the diagnosis is confirmed in only a third of newborns.
2. 2 At the age of up to 20 years, the disease is often associated with the presence of congenital additional renal vessel leading to compression of the pelvis or the initial part of the ureter.
3. 3 In young patients (20-40 years old), the main cause of dilatation is, in males over sixty years old -.
4. 4 Until the age of 20, men and women get sick equally often. In the interval of 20-60 years, the pathology is more often detected in women (the main cause is pregnancy and malignant tumors of the reproductive system).

2. Classification

Hydronephrosis can be:

1. 1 Physiological (during pregnancy, in children)/pathological.
2. 2 By localization: one-sided (right or left)/two-sided.
3. 3 According to the causes of occurrence: primary (congenital) and secondary (acquired). Secondary is a complication of an existing disease (prostate hypertrophy, ureteral tumors, stones, urinary tract injuries, etc.).
4. 4 According to the presence of infection: aseptic and infected.
Table 1 - Stages of hydronephrosis

3. Causes of the disease

As a rule, hydronephrosis occurs against the background of other diseases. The main reasons are:

1. 2 Congenital pathology (congenital strictures, ureteral valves, accessory renal vessels).
2. 5 Blockage of urinary drainage by blood clots.
3. 6 Injuries and surgical interventions.
4. 7 Tumors growing into the organs of the urinary system.
5. 8 Urinary tract infections.
Table 2 - Main causes of hydronephrosis

Block localization	Provoking diseases
Bladder	Cancer, stones. Cystocele. Neurogenic bladder. Diverticula. Vesicoureteral reflux. Hypertrophy of the bladder neck.
Ureter	Strictures. Ureteral valves. Benign polyps ureter. Tumors of the ureter. Intraluminal stones. Ureterocele. Endometriosis. Tuberculosis. Infectious inflammation. Retroperitoneal tumors. Retroperitoneal fibrosis. Uterine prolapse. Pregnancy. Radiation therapy.
Urethra	Stricture, urethral valve. Urethral diverticula. Atresia. Hypo-/epispadias. Hyperplasia, prostate cancer. Cancer of the urethra, penis. Phimosis.

In women, hydronephrosis can often be caused by:

1. 1 Pregnancy.
2. 2 Uterine prolapse. Prolapse of the uterus leads to displacement of the bladder and ureters, which can cause blockage of their lumen.
3. 3 Cystocele. With this pathology, the wall of the bladder may sag into the vagina. Normal emptying of the bladder is disrupted, and the pressure inside it increases. This leads to reverse flow of urine into the ureter and the development of hydronephrosis.

4. How does hydronephrosis develop?

When a block occurs at any level (ureter, bladder, urethra), urine begins to accumulate above this place, and consequently, the pressure in the collecting system increases.

Increased pressure in the collecting system leads to disruption of blood supply and damage to the renal parenchyma.

If the block develops gradually or exists for a sufficiently long time, then this process is called hydronephrotic transformation. It is characterized by irreversible expansion of the calyces and pelvis, gradual atrophy and fibrosis of the renal tissue, a decrease in the thickness of the parenchyma and the development of chronic renal failure (abbreviated as chronic renal failure).

Stagnation of urine contributes to the development of an ascending infection, which often complicates the course of the underlying disease.

5. Main symptoms

Quite often the disease is asymptomatic, and the first signs are detected when there is significant damage to the kidney tissue. Main clinical symptoms of the pathology:

1. 1 Pain in the side or back, lumbar region. The intensity and nature of the pain may vary (dull pain with pyelonephritis, sharp, paroxysmal pain with renal colic).
2. 2 Nausea and vomiting.
3. 3 Frequent, painful urination.
4. 4 The appearance of blood in the urine.
5. 5 General weakness.
6. 6 Fever due to associated infection.

6. Diagnostics

It is extremely important to identify pathology in a timely manner. Delaying treatment may result in permanent kidney damage.

6.1. Inspection

When examining the abdomen and severe hydronephrosis, the doctor may abdominal wall palpate enlarged kidneys.

An obstruction to the outflow of urine at the level of the prostate leads to stagnation of urine in the bladder and its overstretching. In this case, the bubble is also palpated above the pubis. With bilateral hydronephrosis, the patient may experience swelling of the legs.

Additionally performed finger examination rectum: the state of the tone of the anal sphincter and prostate is examined.

6.2. Laboratory research

1. 1 . The study is performed to exclude a urinary infection. In the presence of inflammation, the analysis determines bacteria; the protein content and the number of epithelial cells may moderately increase. ) sometimes indicate the presence of a stone or tumor.
2. 2. The presence of signs of infection in the TAM requires bacterial culture to determine the sensitivity of microbes to the main antibiotics. The study allows you to choose the right antibacterial drugs.
3. 3 General blood test. An increase in the level of leukocytes and ESR is observed during an infectious-inflammatory process.
4. 4 A blood chemistry test is performed to assess renal function. In case of bilateral damage accompanied by renal failure, the analysis determines increased level creatinine and urea.
5. 5 – if a prostate tumor is suspected.
6. 6 Cytological examination of urine is performed when a tumor process cannot be excluded.

6.3. Ultrasound and other methods

Ultrasound diagnostics is used to assess the degree of dilatation of the pyelocaliceal system, identify stones, and determine the condition of the renal parenchyma.

Table 3 - Degrees of hydronephrosis according to ultrasound

Degree	Description
0 tbsp	There is no expansion of the collecting system. The walls of the cups are located next to each other.
1 tbsp	Dilatation of the pelvis without involvement of the calyces. There is no atrophy of the renal parenchyma.
2 tbsp	Dilation of the pelvis and calyces without atrophy of the renal parenchyma.
3 tbsp	Moderate expansion of the pelvis and calyces, dullness, flattening of the renal papillae. Moderate thinning of the renal parenchyma.
4 tbsp	Marked dilatation of the pelvis and calyces, which appear swollen. Loss of boundaries between the calyces and the pelvis. Atrophy.

TO instrumental methods also include:

1. 1 Radiography abdominal cavity. It is used for suspected urolithiasis.
2. 2 Computed tomography. The method is more sensitive compared to ultrasound. Main indications: questionable results ultrasound examination or its lack of information.
3. 3. The patient is injected into a vein, which is excreted by the kidneys and “enhances” the contours of the calyces, pelvis and ureters on the radiograph. Impaired kidney function leads to a slower removal of contrast and its later appearance on the image on the affected side. When the lumen of the ureter is blocked, the contrast accumulates above the block, this is very clearly visible in the image.
4. 4 Dynamic nephroscintigraphy is based on the introduction of a radiodrug into a vein and subsequent recording of radiation from the patient’s body. The study assesses the filtration function of the kidneys.
5. 5 Victory cystoureterography is performed to exclude vesicoureteral reflux. Contrast is injected into the bladder through a urinary catheter and a series of x-rays are taken. The results obtained allow us to assess the presence and degree of reverse urine flow.
6. 6 Cystoscopy, ureteroscopy: an endoscope is inserted through the urethra into the cavity of the bladder and ureter, and then the inner wall and cavity of these organs are examined.

7. Indications for hospitalization

Emergency hospitalization is indicated for:

1. 1 (pain relief, solution to the issue of stone removal and drainage).
2. 2 (antibiotic therapy, resolving the issue of nephrostomy).
3. 3 Spontaneous rupture of the collecting system, kidney (nephrectomy).
4. 4 Terminal stage of chronic renal failure - replacement therapy (hemodialysis, peritoneal dialysis).

Planned hospitalization is performed to confirm the diagnosis, additional examination and planned surgical intervention.

8. Treatment of hydronephrosis

The main goal of therapy is to resume the normal outflow of urine from the kidneys and reduce the pressure in the lumen of the renal pelvis.

Conservative treatment includes:

1. 1 Dynamic observation - at the initial stage of the disease, when the function of the second kidney is preserved, and the obvious cause of the pathology has not been established. This tactic is used, as a rule, in children and pregnant women (with functional hydronephrosis). Observation time is about 6-8 months with subsequent re-examination.
2. 2 Drug treatment is limited to the use of painkillers and the prevention of infectious complications (pyelonephritis).
3. 3 Difficulty in outflow from the bladder (with prostate hypertrophy) in combination with hydronephrosis requires the installation of a urinary catheter. Difficulty inserting a Foley catheter suggests urethral stricture, prostatic hypertrophy, or bladder neck contracture.
4. 4 If urate stones are present, the patient can be treated with diet and medications that alkalinize the urine.
5. 5 For retroperitoneal fibrosis, patients are prescribed glucocorticosteroid therapy.

9. Surgical treatment

Most patients require surgical treatment (from minimally invasive to major open surgery).

The primary task is to normalize the flow of urine from the kidney as quickly as possible (cystostomy, puncture nephrostomy) and prevent damage to its parenchyma. Subsequently, reconstructive operations are performed on the collecting system.

9.1. Temporary drainage

1. 1 – setting drainage tube into the lumen of the bladder. The procedure is used for blockages at the level of the bladder neck and urethra (urethral strictures, prostate hypertrophy), when it is impossible to place urinary catheter. After local anesthesia A small incision is made above the womb and, under the control of an ultrasound machine, a trocar with drainage is inserted into the lumen of the bladder.
2. 2 Puncture nephrostomy - placement of drainage into the cavity of the pelvis under ultrasound control. The method is used for chronic pyelonephritis, progression of renal failure and bilateral hydronephrosis, a single functioning kidney, or for the purpose of stopping pain syndrome.
3. 3 Placement of a stent in the ureter is used when it is compressed from the outside (tumor germination, retroperitoneal fibrosis), lumen stones. The intervention allows for urine diversion to bypass the obstruction. During the procedure, cystoscopy and retrograde pyelography are performed (catheterization of the ureter, administration of contrast, positioning of the stent and taking a series of images).

9.2. Operations for hydronephrosis

All operations performed for pathology can be conditionally classified:

1. 1 Open.
   • Resection of the narrowing area with the formation of a new anastomosis (ureteropyeloanastomosis).
   • Nephrectomy – removal of a kidney. The operation is performed in cases of severe parenchymal damage and critical renal failure.
2. 2 Endoscopic (cystoscopy). During cystoscopy, an endoscope is inserted through the urethra into the cavity of the bladder and access to the confluence of the ureter is provided. The endoscope camera displays all manipulations on the monitor.
   • Bougienage is the gradual expansion of a narrowing area using rigid rods of different diameters.
   • Balloon dilatation (expansion using a balloon, inflating dilator).
   • Endotomy - cauterization of the affected area using a laser.
3. 3 Laparoscopy: unlike cystoscopy, all manipulations are carried out from the abdominal cavity, into which instruments and a camera are inserted through small incisions (up to 1 cm).
   • Laparoscopic reconstruction (excision of the narrowing area with subsequent restoration of ureteral continuity).
   • Laparoscopic nephrectomy.

After any intervention, a temporary stent is placed in the lumen of the ureter to prevent recurrence of stenosis.

Recovery after surgery:

1. 1 Approximately a month after the operation, the ureteral stent is removed and ultrasound control is performed. If necessary, carried out excretory urography.
2. 2 Radioisotope scanning is performed once a year.
3. 3 Laboratory tests (CBC, OAM) are carried out before stent removal, then every 3 months during the first year.
4. 4 12 months after surgery, frequency of ultrasound and laboratory research decreases to 1 time/year.

10. Hydronephrosis during pregnancy

In 8 out of 10 women it is determined physiological expansion pyelocaliceal system, which is provoked by compression of the ureter by the growing fetus. Most often, dilatation of the pelvis and calyces is detected when carrying the first child.

Initial changes are observed in the second trimester, more pronounced with right side, less - with the left. Although naturally occurring, external compression of the ureter and obstruction of urine outflow increase the risk of ascending urinary infection and pyelonephritis.

Basic measures to prevent pyelonephritis - drinking plenty of fluids and positional therapy (knee-elbow positioning, which must be done several times a day). In this case, the amniotic sac moves to the anterior wall of the abdomen, reducing pressure on the ureters. With frequent pyelonephritis and deterioration of urine outflow into the ureter, a stent may be installed.

11. Forecast

The outcome of the disease depends on maintaining a satisfactory urine passage and the degree of renal dysfunction.

With unilateral lesions, the prognosis is usually favorable. With hydronephrosis of both kidneys, the risk of developing chronic renal failure (CRF) and irreversible changes in the parenchyma significantly increases.

- this is a progressive expansion of the pyelocaliceal complex with subsequent atrophy of the renal parenchyma, developing as a result of a violation of the outflow of urine from the kidney. Manifested by lower back pain (aching or renal colic type), hematuria, painful frequent urination, arterial hypertension. Diagnosis may require ultrasound of the bladder and kidneys, bladder catheterization, intravenous urography, cystourethrography, CT or MRI of the kidneys, pyelography, renal scintigraphy, nephroscopy. Treatment of hydronephrosis involves eliminating the cause of impaired urinary passage; The emergency method is nephrostomy.

General information

Hydronephrosis or hydronephrotic transformation of the kidney is a consequence of a violation of the physiological passage of urine, which leads to pathological expansion of the renal cavities, changes in the interstitial renal tissue and atrophy of the parenchyma. At the age of 20 to 60 years, the incidence of hydronephrosis is higher in women, due to reasons related to pregnancy and gynecological cancer. After 60 years, hydronephrosis more often develops in men, mainly against the background of prostate adenoma or prostate cancer.

Causes of hydronephrosis

The causes of the disease are variable, but can be divided into two groups: caused by obstruction or obstruction in any part of the urinary system (ureters, bladder, urethra) or reverse flow of urine caused by incompetent bladder valves. According to the location and nature, the causes of hydronephrosis can be internal, external and functional.

At the level of the ureters internal reasons development of hydronephrosis are more often tumors, fibroepithelial polyps, blood clots, calculi, fungal lesions of the urethra (aspergilemma, mycetoma), ureterocele, tuberculosis, endometriosis, etc. Externally, an obstacle to the passage of urine in the ureteral segment can be created by retroperitoneal lymphoma or sarcoma, pregnancy, cervical cancer, uterine prolapse, ovarian cysts, tubo-ovarian abscess, prostate tumors, aneurysm abdominal region aorta, lymphocele, abnormally located renal artery, compressing the ureter.

On the part of the bladder, internal factors for the development of hydronephrosis can be urolithiasis, cystocele, carcinoma, bladder diverticulum, bladder neck contracture. Functional disorders include the presence of a neurogenic bladder and vesicoureteral reflux. An external obstruction to the flow of urine from the bladder can occur with pelvic lipomatosis. Among internal lesions In the urethra, the development of hydronephrosis is facilitated by diverticula, urethral strictures, and urethral atresia. External obstacles, as a rule, are prostate hyperplasia and cancer.

With hydronephrosis, damage to the urinary tract at various levels can also be caused by congenital dyskinesia and obstruction of the urinary tract, their injuries, inflammation (urethritis, cystitis), damage spinal cord. When an obstacle to the outflow of urine is localized below the ureteropelvic segment, not only the pelvis, but also the ureter expands, which leads to hydroureteronephrosis.

Pathogenesis

Impaired urine flow leads to increased pressure inside the ureter and pelvis, which is accompanied by noticeable impairments in glomerular filtration, renal tubular function, pyelolymphatic flow, pyeloarterial and pyelovenous blood flow. The outcome of hydronephrosis is atrophy renal tubules and death of the structural units of the kidney - nephrons.

Classification

Depending on the time of development, hydronephrosis can be primary (congenital) or acquired (dynamic). According to the severity of the course, mild, moderate and severe hydronephrosis is distinguished; by localization - one-sided and two-sided. In practical urology, hydronephrosis of the right and left kidney occurs with equal frequency; bilateral hydronephrotic transformation is observed in 5-9% of cases.

The course of hydronephrosis can be acute or chronic. In the first case, with timely correction, complete restoration of renal function is possible; in the second, kidney function is lost irreversibly. Depending on the presence of infection, hydronephrosis can develop aseptic or infected type.

Symptoms of hydronephrosis

Manifestations of pathology depend on the location, rate of development and duration of obstruction of a segment of the urinary tract. The severity of symptoms is determined by the degree of expansion of the renal pyelocaliceal complexes. Acute hydronephrosis develops rapidly, with severe paroxysmal pain in the lower back, similar to renal colic, spreading along the ureter, into the thigh, groin, perineum, and genital area. There may be an increased urge to urinate, painful urination, nausea and vomiting. With hydronephrosis, blood appears in the urine, visible to the eye (macrohematuria) or determined in the laboratory (microhematuria).

Unilateral aseptic chronic hydronephrosis remains latent for a long time. In most cases, there is discomfort in the lumbocostal angle, periodic dull pain in the lower back, which worsen after physical activity or intake large quantity liquids. Over time, chronic fatigue and decreased ability to work progress, transient arterial hypertension occurs, and hematuria appears. With an increase in body temperature, as a rule, one should think about infected hydronephrosis and acute purulent obstructive pyelonephritis. In this case, pus appears in the urine (pyuria). A pathognomonic sign for hydronephrosis is the patient's preference to sleep on his stomach, since this position leads to changes in intra-abdominal pressure and improving the outflow of urine from the affected kidney.

Complications

Chronic hydronephrosis often contributes to the occurrence of urolithiasis and pyelonephritis, hypertension, which further aggravate the clinical picture of hydronephrotic transformation of the kidney. Sepsis sometimes develops against the background of infected hydronephrosis. The course of hydronephrosis may be complicated by the development of renal failure. In this case, especially with bilateral hydronephrosis, the patient’s death occurs from intoxication with nitrogen metabolism products and water disturbances. electrolyte balance. A life-threatening complication of hydronephrosis can be spontaneous rupture of the hydronephrotic sac, resulting in urine leakage into the retroperitoneal space.

Diagnostics

For hydronephrosis, the diagnostic algorithm consists of collecting anamnestic data, conducting a physical examination, laboratory and instrumental studies. In the process of studying the anamnesis, the nephrologist finds out the presence of reasons that may contribute to the development of hydronephrosis. Physical data are uninformative and nonspecific.

With deep palpation of the abdomen, a distended bladder can be detected; in children and thin adult patients, an enlarged kidney can be detected. Percussion of the abdomen in the area of ​​the altered kidney, even with slight hydronephrosis, reveals tympanitis. For renal colic, tension and bloating, bladder catheterization is often used. The release of a large volume of urine through the catheter may indicate obstruction at the level of the urethra or bladder outlet.

The defining methods for diagnosing hydronephrosis are radiological and ultrasound examinations. Ultrasound of the kidneys is performed polypositionally, examining longitudinal, transverse, oblique projections with the patient positioned on the stomach and side. During echography, the size of the kidneys, the condition of the pyelocaliceal complexes, the presence of additional shadows, and the condition of the ureters are assessed. If necessary, an additional ultrasound of the bladder is performed to determine the amount of urine and ultrasound of the kidney vessels. Endoluminal echography allows identifying changes in the area of ​​the ureteropelvic segment and periureteric tissue.

The priority for identifying hydronephrosis is X-ray contrast studies, primarily excretory urography and retrograde ureteropyelography, which allow one to judge the excretory function of the kidney. In some cases, to determine the causes of kidney obstruction during hydronephrosis, chromocystoscopy, renal angiography, percutaneous antegrade pyelography, MRI and CT of the kidneys are used. Radioisotope dynamic nephroscintigraphy and renoangiography are used to assess organ blood flow.

Can be used to visualize obstructions to the outflow of urine in hydronephrosis. endoscopic methods– ureteroscopy, cystoscopy, ureteroscopy, nephroscopy. Signs of impaired renal function in hydronephrosis can be detected by blood and urine tests. Biochemical blood parameters are characterized by increased levels of creatinine, urea, and changes in electrolyte balance (sodium, potassium). IN general analysis urine is determined by leukocyturia, pyuria, hematuria. If necessary, the Reberg, Zimnitsky, Nechiporenko, Addis-Kakovsky test and urine culture are examined.

Hydronephrosis should be distinguished from conditions with similar symptoms that are not complicated by hydronephrotic transformation of the kidney - kidney stone disease, nephroptosis, polycystic disease, kidney cancer.

Treatment of hydronephrosis

Conservative therapy is ineffective. It can be aimed at relieving pain, preventing and suppressing infection, lowering blood pressure, and correcting renal failure in the preoperative period. Emergency treatment method acute hydronephrosis Percutaneous (percutaneous) nephrostomy is used, which allows you to remove accumulated urine and reduce pressure in the kidney.

Kinds surgical treatment hydronephrosis can vary and is determined by the cause this state. All methods of surgical treatment of hydronephrosis are divided into reconstructive, organ-preserving and organ-removing. Indications for reconstructive plastic surgery are the preservation of parenchymal function and the possibility of radical elimination of the cause of hydronephrosis. For urethral strictures or ureteral strictures, balloon dilatation, bougienage, endotomy, and ureteral stenting are performed.

In cases of obstruction caused by prostate hyperplasia or cancer, prostate resection, urethral dilatation, prostatectomy, or hormone therapy. In case of urolithiasis, lithotripsy or surgical removal stones from the obstruction zone. Open operations performed for retroperitoneal tumors, aortic aneurysm, impossibility of endoscopic stenting or shock wave lithotripsy. Nephrectomy - removal of a damaged kidney - is resorted to when its function is lost and there is a risk of complications.

Prognosis and prevention

Rapid elimination of the causes of hydronephrosis allows the kidney to restore its functions due to its large reserve capacity. In case of prolonged obstruction, damage to another kidney, or infection, the prognosis of hydronephrosis is serious. The development of hydronephrosis can be prevented by undergoing periodic examinations by a urologist with ultrasound of the kidneys and preventing urinary tract diseases.