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Obstruction and reflux occur fairly commonly in the duplex kidney. Although obstruction with attendant hydronephrosis is more frequently seen in the upper pole of a duplex system, a similar process involving the lower pole should be considered in the differential diagnosis of renal mass lesions. Four cases are described in which lower pole hydronephrosis simulated neoplasm.
Among eight patients with unilateral hydronephrosis and hypertension, peripheral plasma renin activity was normal in seven and borderline high in one. Four patients had hydronephrotic/contralateral kidney renin ratios of greater than 1.5, suggesting excessive renin release from the diseased kidney, and ratios between contralateral kidney and peripheral blood of less than 1.2, indicating suppressed renin production in the contralateral kidney. Nephrectomy normalized blood pressure in each of these patients. Two patients had hydronephrotic/contralateral kidney renin ratios of less than or equal to 1.3 or contralateral kidney/periphery ratios of greater than 1.2, suggesting ischemia of the contralateral kidney; pyeloplasty or nephrectomy, or both, failed to improve the hypertension. Postoperative changes in blood pressure correlated with changes in peripheral renin (r = 0.90; P less than 0.01). These data suggest that hypertension associated with unilateral hydronephrosis is partly renin-dependent; and renal vein renin values are helpful in selecting patients for surgery.
Within the 10 years' period, from 1968 to 1977, 8 children were renal trauma in hydronephrosis were operated upon in the Children's Surgery Clinic in LPMI. 7 patients underwent nephrectomy and one--the plasty of the pyeloureteral segment. The surgical intervention carried out immediately after trauma prevents the occurrence of complications and, sometimes, helps to preserve the kidney. The immediate and late results of the surgical treatment are good, which proves the necessity of an urgent examination and active surgical tactics in case of injury to the kidney in hydronephrosis in children.
The analysis of 120 cases of hydronephrosis and 124 of corrective operations of hydronephrosis (4 bilaterally) from the Urological Clinic in Belgrade, with 81.5% very good and good results, showed the endresult which is dependent from the correctness of the indication for surgical corrective treatment, adequacy of the performed type of the corrective operation, the correctness of its performance, lack of complications and its abolishment even more from anatomical resp. functional state of the kidney before the operation. Less damaged kidneys precede well, and developed damage has a bad prognosis of the corrective operation.
The authors present the experience acquired by the Urology Department of "La Paz" Hospital in the sonographic diagnosis of hydronephrosis over a period of one year. In 47 patients, the percentage of successful diagnoses reached 93.7%, including 32 cases with a silent kidney in the intravenous urography. They discuss the different sonographic patterns of hydronephrosis, in relation to its degree of evolutionary development and its differential diagnosis with other kidney disorders.
The authors report on the results of surgical treatment of 17 children with bilateral hydronephrosis. Corrective operations gave better results in patients who had not yet developed irreversible structural changes in the kidneys. The authors believe that an early detection of hydronephrosis and removal of obstructions to normal urinary outflow from the kidneys are necessary.
The pathogenesis of experimental unilateral hydronephrosis was studied in the rat, with emphasis on the role of medullary vascular obstruction. The medullary circulation was evaluated after increasing periods of ureteral obstruction (up to 48 hours) using in vivo perfusion of silicone rubber or colloidal carbon. Evidence of inner medullary hypoperfusion was seen after 1 hour, and by 6 hours, the entire papilla was ischemic. Papillar hypoperfusion was still present at 24 and 48 hours, but significant recirculation occurred in the presence of continued obstruction. Release of ureteral obstruction caused rapid reversal of the perfusion defect. Histologic studies of the renal parenchyma adjacent to the pelvis showed increasing vascular congestion, focal interstitial edema, and extravasation of erythrocytes; these changes were also diminished after release of obstruction. Endothelial swelling or thrombosis in inner medullary blood vessels was not observed. Inner medullary tubules showed degenerative changes in kidneys that had been obstructed for 6 hours or more; at later periods (18 hours or more) focal necrosis was seen, but it never involved the entire papilla. Thus, reversible collapse of inner medullary blood vessels occurs in acute unilateral hydronephrosis and may provide the basis for the development of ischemic tubular damage. The findings suggest that the vascular obstruction may be due to increased intrapelvic pressure, rather than endothelial swelling or thrombosis. The vascular-tubular defect may be relevant to the altered medullary physiology observed in this condition.
Five patients are reported with uretropelvic obstruction and hydronephrosis in which the renal pelvis is predominantly involved. Because of the extrarenal position of the pelvis in these patients, its dilatation is apt to cause distortion and displacement of the calyces and infundibulae simulating an intrarenal mass. Calyceal and infundibular dilatation is much less apparent and general renal outline and cortical thickness is better preserved in these patients than in those with classical hydronephrosis. Careful attention to radiographic technique including delayed films, ultrasonography and occasional arteriography should prevent any confusion with a solid mass lesion.
The authors report 22 cases of uretero-ileo-plasty for uretero-hydronephrosis due to schistosomiasis. The indications for operation depend on the following criteria: the degree of dilatation which varies from simple atonia to very large hydronephrosis which one must not wait for, ureteral stenosis, vesico-ureteral reflux, the degree of renal failure assessed by studies of creatinine and urea clearance and the resistance to treatment. The operative technique which is not specific for bilharziasis includes uretero-ileo-plasty which is often bilateral, for even in asymmetrical cases, the least affected ureter is often of poor quality. There were failures in two cases due to irreversible renal failure, and in two cases, due to peritonitis. The late results of the other cases appear very favourable: increased vesical capacity, diminution of cystalgia, comfort and improved, general health, were the main factors. Stenosis of the anastomosis, vesico-ureteral reflux and urinary infection, acidosis, lithiasis are rare or not very severe.
Four hundred ninety-two patients, including 449 pregnant patients, 39 nonpregnant control patients, and 4 patients with pelvic masses, had renal ultrasonography using gray scale technique. Measurements of renal pelvic diameters in the normal pregnant patients revealed an overall incidence of 63 percent renal pelvic dilatation over the nonpregnant controls. Maximum normal renal pelvic diameters were 1.1 cm on the right and 0.9 cm on the left. The maximum normal expected renal pelvic diameter (97.5 percent confidence level) in pregnancy is 2.7 cm on the right and 1.8 cm on the left in the last two trimesters of pregnancy. There was no significant difference between primiparous and multiparous patients, but pregnant patients were significantly different from controls in every trimester (p less than 0.01). Maximum dilatation occurred at 24--28 weeks of gestation. The right renal pelvis was enlarged to the greatest degree in 90 percent of normal patients. Patients with pelvic masses showed a similar pattern of right-sided hydronephrosis.
A case of hydroneophrosis is reported in which the diagnosis has been confirmed on the ground of renal echography. The physical principles of the method are outlined. Its expediency, safety and efficiency are emphasized. It is considered the most reliable diagnostic procedure if hydronephrosis is suspected in case of renal occlusion.
The use of ultrasonography in the diagnosis of upper abdominal masses with nonfunctioning kidneys is described. Two cases of congential hydronephrosis due to obstruction of the pelviuretic junction are presented, both of which were diagnosed by B-scan ultrasound examination. Diagnostic ultrasound is a simple, noninvasive and reliable method of differentiating cystic from solid lesions and of assessing whether or not a mass is renal or extrarenal. It is recommended that all patients seen with an upper abdominal mass and/or nonfunctioning kidney be examined by ultrasound.
Three unusual cases of hydronephrosis in children secondary to ureteral lesions, (1) congenital abnormality and (2) due to benign tumor, are presented. The radiographic findings and management are discussed. Conservative surgical management is suitable for these lesions.
The ACI rat provides a congenital mammalian model for the spontaneously occurring defects of renal agenesis and hydronephrosis. These anomalies appear to be part of a spectrum of abnormalities caused by a mesonephric duct defect. These same anomalies also exist in man probably more commonly than previously appreciated.
A case of massive hydronephrosis of the upper portion of a duplicated collecting system in a middle-aged male is presented. Computerized tomographic examination of the abdomen provided the most precise information and led to a correct preoperative diagnosis, whereas both urography and ultrasound did not.
Ultrasonography offers a noninvasive method to visualize antenatal or neonatal anatomy which will lead to early detection and treatment of abnormalities. In these 2 cases, ultrasound allowed prompt diagnosis of hydronephrosis despite normal physical examination and laboratory values at birth.
Bladder diverticula are uncommon in infants and are an uncommon cause of hydronephrosis in newborns but can cause significant problems. A thorough diagnostic approach must include both excretion urography and cystourethrography. Early appropriate surgical intervention will result in preservation of renal function.
OBJECTIVE: To compare the quality of life (QoL) and family impact scores of children with posterior urethral valves (PUV), isolated hydronephrosis (HN), and those with minor urologic conditions, referred to here as minor urologic controls (MUC). METHODS: From December 2022 to April 2025, the PedsQL Inventory and Family Impact Module (FIM) questionnaires were distributed to patients in dedicated PUV, HN, and community-based urology clinics. Higher scores indicate better QoL. Children ≥8 years self-completed the questionnaires, while parents served as proxies for younger children. PUV patients were compared to HN patients and MUC. RESULTS: A total of 331 patients were included (124 PUV, 101 HN, and 106 MUC). The median age differed across groups, with HN patients being the youngest (median: 7 months), followed by MUC patients (median: 36 months) and PUV patients (median: 79.5 months). Overall, PUV patients scored similarly to HN patients and MUC in QoL and FIM scores. When stratified by age, however, PUV patients <2 years old had lower median scores in total QoL, psychosocial, and family functioning domains compared to other groups. CONCLUSION: Overall, PUV was not associated with lower QoL or family impact scores compared to comparator groups in this tertiary-care cohort; however, lower scores were observed among younger children with PUV, likely reflecting parent-perceived burden early in the disease course. This highlights the importance of age-tailored support and close monitoring, particularly for younger children and families navigating early post-diagnosis care.