What Surgery Is Done for Hydronephrosis?

Hydronephrosis involves the collection of urine in the kidney due to incomplete emptying of the urinary tract. This results in swelling and obstruction of the kidney. The swelling or obstruction can occur at:

• Opening of the kidneys into the ureters
• The ureters
• The bladder
• The urethra

Hydronephrosis may be of two types:

• Unilateral hydronephrosis (only one kidney is affected)
• Bilateral hydronephrosis (both the kidneys are affected)

Hydronephrosis, if left untreated, can lead to kidney failure.

The most common causes of hydronephrosis include:

• Kidney stones
• Tumors in the bladder or prostate gland
• Benign prostatic hyperplasia (enlargement of the prostate gland causing pressure in the urethra)
• Blood clots in the kidney or ureter
• Strictures (narrowing of the urinary tract)
• Nerve or muscle problems in the kidney or ureters
• Urinary retention
• Vesicoureteral reflux (a condition where urine flows backward from the bladder to the ureter)
• Ureterocele (a condition where the lower part of the ureter may protrude into the bladder)
• Ureteropelvic junction obstruction (blockage at the point where the kidney joins the ureter)
• Ureterovesical junction obstruction (blockage at the point where the ureter joins the bladder)
• Posterior urethral valves (a congenital condition in which there are abnormal flaps of tissue in the urethra)
• Urethral cancer

In women, hydronephrosis may occur as a result of:

• Pregnancy (enlargement of the uterus can exert pressure on the ureters)
• Uterine prolapse (uterus sags down from its normal position)
• Cystocele (a condition where the wall between a woman’s bladder and her vagina weakens and allows the bladder to drop or sag into the vagina)

Hydronephrosis generally doesn’t cause any symptoms. If symptoms occur, they include:

• Nausea
• Vomiting
• Blood in the urine
• Weakness or malaise
• Fever due to a urinary tract infection
• Chest pain
• Shortness of breath
• Leg swelling
• Sudden or intense pain in the back or side of the abdomen
• Cloudy urine
• Painful urination

In the case of electrolyte abnormalities, it may lead to:

• Heart rhythm disturbance
• Muscle spasms

The surgeon takes the history of the patient. They may also ask you to undergo specific tests, which include:

• Lab tests may include urinalysis, complete blood cell count, electrolyte analysis, and blood urea nitrogen or creatinine.
• Imaging studies may include computed tomography scan, ultrasound, intravenous pyelography, or X-ray.

Acute or sudden hydronephrosis can be treated using a stent or soft tube (nephrostomy tube). The stent is inserted through the skin (percutaneously) into the kidney to drain off the urine. Treatment options for kidney or ureteral stones include:

• Shock wave lithotripsy
• Ureteroscopy
• Laparoscopy