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Hydronephrosis accidentally detected by gastrointestinal sonography.

A retrospective study was carried out on patients with gastrointestinal complaints, who were accidentally found to have varying degrees of hydronephrosis between October 1989 and April 1991. The criteria for hydronephrosis given by Ellenbogen et al were used for ultrasonographic diagnosis. Grade 0 and 1 were classified as mild degree and grade 2 and 3 as moderate and severe, respectively. The causes of hydronephrosis were determined by intravenous pyelography, retrograde pyelography, and/or computed tomography. Of 44 patients with hydronephrosis who had complete studies, 20 had a mild degree of hydronephrosis, 18 had a moderate degree, and 6 had a severe degree. All 24 patients with moderate and severe degrees of hydronephrosis had obstruction as the etiology, but only 50% of the cases with mild hydronephrosis were found to have pathological lesions. Urolithiasis (79.4%) was the most common cause of hydronephrosis in this study. Benign prostate hypertrophy, carcinomas, external compression, and tuberculosis followed. Hydronephrosis found accidentally by sonography in the patients with gastrointestinal complaints is significant.

Aged↗

PubMed2006

Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: lessons learned after 16 years of follow-up.

OBJECTIVES: We attempted to define predictive factors for surgery in children with antenatal diagnosis of hydronephrosis that led to postnatal diagnosis of ureteropelvic junction (UPJ) obstruction. METHODS: We retrospectively evaluated our 16-yr experience (1988-2003) with 343 children (260 male and 83 female) with antenatal diagnosis of hydronephrosis that led to postnatal diagnosis of UPJ obstruction and who were followed conservatively. Right-sided hydronephrosis was present in 110 and left-sided in 233 children. According to the Society for Fetal Urology (SFU) classification none had grade 0 of postnatal hydronephrosis, 20 had grade 1, 118 grade 2, 147 grade 3, and the remaining 58 children grade 4 postnatal hydronephrosis. Relative renal function (RRF) on radionuclide scans revealed 235 children with RRF>40%, 68 with RRF between 30% and 40%, and 40 patients with RRF<30%. Renal function deterioration >5% was the main indication for surgery. Commercially available software GraphPad Prism 4.0 (GraphPad prism, Prism 4 for Windows, version 4) using the Fisher exact test was used for statistical evaluation. RESULTS: Surgical correction was needed in 179 children (52.2%) during the course of conservative management. The average age at surgery was 10.6 mo (range, 1 mo to 7 yr). Of those, 50% underwent surgery during the first 2 yr of life and the majority of the remaining patients underwent surgery between the 2 and 4 yr of age; only two patients required surgery later on. Univariate analysis revealed that child sex, side of hydronephrosis, and SFU grade of prenatal hydronephrosis were not significant predictive factors for surgery. However, SFU grade 3-4 of postnatal hydronephrosis (p<0.0001; odds ratio, 0.06281) and RRF<40% (p<0.0001; odds ratio, 0.1022) were significant independent risk factors for surgery. CONCLUSION: In contrast with previous publications by others and by us these data show that >50% of children with antenatal diagnosis of UPJ obstruction in this series required surgical correction while on conservative protocol. SFU grade 3-4 of postnatal hydronephrosis and RRF<40% are significant independent predictive factors for surgery.

Child↗

PubMed2002

Analysis of trends on serial ultrasound for high grade neonatal hydronephrosis.

PURPOSE: We sought to validate the role of serial ultrasound studies for detecting and excluding obstruction in high grade neonatal hydronephrosis. MATERIALS AND METHODS: Between January 1996 and December 1998 all patients with prenatally diagnosed hydronephrosis underwent a protocol of antibiotic prophylaxis, ultrasound and voiding cystourethrography. All reflux-free patients underwent diuretic renography. Patients with high grade isolated unilateral hydronephrosis were included in the study. They were followed with 3 serial ultrasound examinations every 3 months in year 1 of life, biannually in year 2 and yearly thereafter. The trends in the changes in these studies were studied. RESULTS: Of the 153 patients 45 (29%) met study inclusion criteria. During a mean followup of 38 months (range 23 to 52) 16 patients (36%) who showed a trend of progressive hydronephrosis underwent pyeloplasty. The remaining 29 patients showed a trend of improvement in hydronephrosis. The drainage pattern on initial diuretic renography had only 63% sensitivity and 59% specificity for diagnosing obstruction. The same was true for the decrease in differential function of below 40% with 56% sensitivity and 66% specificity. Logistic regression analysis revealed that neither the initial grade of hydronephrosis on prenatal ultrasound nor the drainage-functional pattern on initial diuretic renography was a predictor of the subsequent need for pyeloplasty. All 16 patients who underwent pyeloplasty had improved or stabilized hydronephrosis after pyeloplasty. CONCLUSIONS: A trend of progressive hydronephrosis on 2 consecutive serial renal ultrasound examinations serves as an early diagnostic sign of obstruction. Initial grade of hydronephrosis on initial ultrasound as well initial functional-drainage patterns on diuretic renography are not predictors of obstruction. Serial ultrasound is noninvasive and could replace serial invasive renal scans. Diuretic renal scans still have a role, especially as a baseline study to guide the frequency of serial ultrasound examinations.

Algorithms↗

PubMed2001

Hydronephrosis with diffuse or segmental cortical thinning: impact on renal function.

PURPOSE: Management of hydronephrosis has changed considerably with the routine use of prenatal ultrasonography. Increased dependence is now placed on nuclear renographic differential renal function, and many urologists consider surgical intervention for ureteropelvic junction obstruction with significant decrease in renal function (less than 40%). Correlation between differential renal function and the degree of dilatation diagnosed by ultrasound has not been reported. In addition, no difference between hydronephrosis associated with either diffuse or segmental cortical thinning has been made, as both are classified as grade IV according to the Society of Fetal Urology classification. Based on clinical observation we hypothesized that hydronephrotic grade IV kidneys with diffuse parenchymal thinning are associated with worse renal function and are distinct from those with segmental cortical thinning. MATERIALS AND METHODS: We performed a retrospective study of patients who underwent pyeloplasty between January 1996 and December 1998. Hydronephrosis was graded according to Society for Fetal Urology classification and all diuretic renograms were performed in a standardized fashion. Grade IV kidneys were divided into IVA (segmental cortical thinning) and IVB (diffuse cortical thinning). Statistical correlation of grade and differential renal function was performed using a chi-square test. RESULTS: Images were available for review in 77 patients. Average patient age at intervention was 20.4 months and 7.6 years of the prenatally and postnatally detected hydronephrosis groups, respectively. Of the 77 cases 25 had grade IVA and 18 had grade IVB hydronephrosis. Of the grade IVB hydronephrosis cases 66% had less than 40% differential renal function compared to 24% in group IVA (p <0.05). CONCLUSIONS: Patients with grade IVB hydronephrosis secondary to ureteropelvic junction obstruction have a higher risk of significant decrease in renal function. Group IVA has significantly better function than group IVB and characteristics similar to grade III hydronephrosis cases. Grade IVB hydronephrosis should monitorized closely as earlier intervention may be warranted to avoid progressive deterioration of renal function.

Female↗

PubMed2003

The natural history of hydronephrosis after radical hysterectomy with no intraoperatively recognisable injury to the ureter: a prospective study.

OBJECTIVE: To investigate, in a prospective study, the natural history of hydronephrosis of the urinary tract after radical hysterectomy. PATIENTS AND METHODS: From December 1997 to March 2001, 34 patients with localized cervical cancer underwent radical hysterectomy by one gynaecologist, with no intraoperatively identifiable injury to the ureter. Intravenous urography was used routinely before and at 2 and 4 weeks after surgery. The degree of hydronephrosis was graded I-IV. RESULTS: Urography before surgery showed no abnormal finding in any of the patients, except in one with a unilateral duplex kidney. Hydronephrosis was found in 10 units in the upper tract (grade II in eight, III in one and IV in one) in seven patients (21%) 2 weeks after surgery (one right, three left and three bilateral). All the ureteric narrowing was in the distal ureter. The hydronephrosis disappeared in four units in three patients, but became worse in two units in two patients with bilateral pathology in the fourth week. At 3 months after surgery no hydronephrosis had deteriorated and the hydronephrosis in all units had disappeared by 6 months. The presence of hydronephrosis was significantly correlated with pathological stage and age (P < 0.05). CONCLUSION: Hydronephrosis was detected after radical hysterectomy even with no intraoperatively recognisable injury to the ureter, but in most the hydronephrosis improved spontaneously and needed no ureteric stenting or surgical intervention.

Adult↗

PubMed2001

Hydronephrosis associated with colorectal carcinoma: treatment and outcome.

AIM: Obstruction of the upper urinary tract, hydronephrosis, is not uncommon in the context of primary or recurrent colorectal cancer (CRC). Its presence poses a therapeutic dilemma. This study focuses on the significance of hydronephrosis as a prognostic marker for CRC by analysing the resectability and survival rates of patients affected. PATIENTS AND METHODS: Retrospective data of 52 patients with hydronephrosis were analysed. Ten had primary CRC at different sites and 42 developed hydronephrosis 1-84 months following resection of a primary CRC. Twenty eight had unilateral and 24 bilateral hydronephrosis. RESULTS: In 10 patients with primary CRC and in 38 of those with a history of CRC, hydronephrosis was secondary to malignant obstruction. In four it was related to iatrogenic injury to the urinary tract. Complete surgical resection was possible in five patients (10%) with malignant obstruction. The remaining 90% underwent palliative or no surgical treatment due to diffuse metastasis or extensive local disease. No difference in survival was found between these two groups (6 vs 8 months) nor when comparing CEA levels, Duke's staging, or unilateral vs bilateral hydronephrosis. Patients with benign obstruction were treated by a ureteric stent, leading to resolution of hydronephrosis. All four are alive. CONCLUSIONS: Malignant hydronephrosis, secondary to primary or recurrent CRC, represents local manifestation of a disseminated disease with almost no probability of long-term survival and cure. It would seem that patients with such disease do not benefit from aggressive operations.

Adult↗

PubMed2003

Clinical characteristics and outcome of hydronephrosis detected by prenatal ultrasonography.

The widespread use of prenatal ultrasound results in an increased recognition of fetal hydronephrosis. To determine clinical characteristics and postnatal outcome of fetal hydronephrosis, we performed a retrospective study in children diagnosed as having fetal hydronephrosis between 1990 and 2001. 341 children with 427 dilated kidneys were included. Dilatation of the renal pelvis was caused by primary ureteropelvic junction obstruction in 65.6%, multicystic kidney in 9.4%, vesicoureteral reflux in 7.0%, duplex system in 5.4%, ureterovesical junction obstruction in 4.0%, and posterior urethral valves in 3.0%. Hydronephrosis resolved spontaneously in 126 (29.5%) kidneys, with 52.7% of mild hydronephrosis, and 2.6% of severe hydronephrosis. Mean interval to spontaneous resolution was 1.39 (+/- 1.41, SD) yr. Surgery was performed in 174 kidneys, including pyeloplasty in 105, ureteroneocystostomy in 23, transurethral incision in 11 and nephrectomy in 9. Most patients had initially high-grade hydronephrosis (p<0.05). Mild hydronephrosis appears to be relatively benign, and in most cases, dilatation improves with time, and thus surgical intervention is not required. On the other hand, moderate or severe hydronephrosis often results in a significantly poor outcome and requires surgical intervention, and therefore, requires closer follow-up both antenatally and postnatally.

Adolescent↗

PubMed1991

Hereditary hydronephrosis in C57BL/KsJ mice.

We sought to determine if the incidence of renal hydronephrosis in male C57BL/KsJ mice increased with age and if grossly normal kidneys would develop hydronephrosis over time. Spontaneous hydronephrosis was found incidentally in 32% of 234 male C57BL/KsJ mice killed as pancreas donors for islet transplantation experiments. The incidence of hydronephrosis increased with age; the incidence was 15% in 6- to 8-week-old mice, 52% in 8- to 10-week-old mice and 63% in 11- to 15-week-old mice (P less than 0.001). Additional mice received islet isografts beneath the renal capsule. Only mice with grossly normal kidneys received islet grafts. These same kidneys were then re-examined when the graft recipients were killed at the end of the experiment and the incidence of hydronephrosis was determined. The conversion of normal kidneys to hydronephrotic kidneys increased with the time since islet transplantation. Kidneys re-examined less than 4 weeks since transplantation had only 5.8% new hydronephrosis, while those re-examined later than 4 weeks after transplantation had a new hydronephrosis incidence rate of 40% (P less than 0.001). Our findings suggest that hydronephrosis is hereditary but not congenital, that it develops rapidly, and that it can complicate experiments using this strain. This may also represent a useful new animal model of progressive hydronephrosis.

Age Factors↗

PubMed1994

Outcome of nonspecific hydronephrosis in the infant: a report from the Registry of the Society for Fetal Urology.

Since 1988 the Society for Fetal Urology has worked to evaluate if there is consensus on management of infants with nonspecific hydronephrosis. Initially, multicenter agreement on the criteria to grade hydronephrosis and method of diuretic renography were developed to promote similarities in how infant kidneys with nonspecific hydronephrosis were profiled for grade (0 to 4), per cent differential function by diuretic renography and drainage response by diuretic renography (obstructed, not obstructed or indeterminate). Between 1989 and 1992 a total of 33 pediatric urologists from 21 cities registered 464 cases (582 kidneys) of hydronephrosis. Of the cases 275 (59%) were managed by observation and 189 (41%) were treated surgically. The operated kidneys showed profiles (hydronephrosis grade 3 or greater and diuretic renography obstructed) that were significantly different from the profiles of observed kidneys (hydronephrosis grade 2 or less and diuretic renography no obstruction) (p < 0.001 each). Six months postoperatively the mean grade of hydronephrosis (1.8) and diuretic renography diagnosis (no obstruction) were significantly better than they were preoperatively (p < 0.001 each). In addition, postoperatively the mean grade of hydronephrosis, diuretic renography diagnosis and per cent differential function were similar to age matched observed kidneys. We conclude that when radiographic tests are done similarly, there is consensus in the management of infant hydronephrosis by surgery or observation.

Databases, Factual↗

PubMed1976

Hydronephrosis in the mouse: the effects of the short-ear gene, sex and ureteral vascular system.

The short-ear gene in the mouse, se, affects a number of soft tissues; skeletal effects result in reduced body cavities. A high incidence of hydronephrosis in short-ear genotypes has been ascribed to pressure on the lower ureter resulting from crowding of organs in the body cavity. This study concerns the ureteral vascular system as observed in 861 autopsies of mice of varying age, of the three short-ear genotypes, drawn from ten stocks. Incidence and expression of hydronephrosis is greater in short-ear males than in females, and the ratio between the two varies from one stock to another. This study seeks an explanation. Short-ear genotypes have an abnormally high incidence of unusual ureteral veins, hydronephrosis being strongly associated with the more posterior ones. Ureteraonadal and iliac veins. The spermatic vein's more posterior position, compared with the ovarian, is strongly correlated with the sex difference in posterior ureteral venation and thus with the sex difference in incidence of hydronephrosis. Stocks are compared according to the amount of selection for fitness of short-ear genotypes; there is a reduced incidence of hydronephrosis with selection, accompanied by fewer posterior ureteral veins. Age also affects hydronephrosis; its expression increases slightly with age, and the male sese progeny of young mothers appear to be particularly prone to hydronephrosis. Three skeletal mutants segregate; of these fidget, fi, causes a type of hydronephrosis differing somewhat from that caused by se.

Age Factors↗

PubMed1989

Hydronephrosis in advanced ovarian carcinoma.

In a consecutive series of 232 patients with ovarian carcinoma, (FIGO IIB-IV), receiving combination chemotherapy, 52 patients (22%) presented with (early, 69%) or developed (late, 31%) hydronephrosis diagnosed by intravenous pyelography or abdominal ultrasound scan. Unilateral hydronephrosis was seen in 77%, bilateral in 23%. Patients with hydronephrosis were characterized by stage IIIB-IV (67%), and primary residual tumor size greater than 2 cm (81%). Nine patients (17%) developed concomittantly impaired renal function diagnosed by a rise in se-creatinine and/or a decrease in 51Cr-EDTA clearance. No difference in survival was seen in patients with early or late hydronephrosis, nor with uni- or bilateral hydronephrosis, but patients with hydronephrosis at the start of chemotherapy lived significantly shorter than those without hydronephrosis, P less than .05. In conclusion, hydronephrosis is a common complication to advanced ovarian carcinoma, and the presence of this complication at the start of chemotherapy has a negative impact on survival.

Adult↗

PubMed2006

Hydronephrosis as a prognostic marker in bladder cancer in a cystectomy-only series.

OBJECTIVES: Hydronephrosis in patients with bladder cancer is caused by tumour at the ureteral orifice, secondary ureteral tumours, intramural or extravesical tumour infiltration, or compression of the ureter. This study investigated the prognostic impact of hydronephrosis in bladder cancer. METHODS: A series of 788 patients were treated with radical cystectomy with curative intent for transitional cell carcinoma of the bladder without neoadjuvant/adjuvant radiotherapy/chemotherapy between January 1986 and September 2003. All patients had a complete follow-up until death or until the study's end date. Survival rates were calculated using the Kaplan-Meier method. A multivariate analysis with a Cox regression model was performed with respect to potential influencing factors. RESULTS: A total of 108 patients (13.7%) had unilateral and 25 patients (3.2%) had bilateral hydronephrosis. The rate of organ-confined tumours was significantly higher in patients without hydronephrosis (67.9% vs. 37.6%; p<0.001). Forty-three (32.3%) of the 133 hydronephrotic patients had a tumour involving the ureteral orifice. In this group the rate of organ-confined tumours was significantly higher than in the other patients with hydronephrosis (53.5% vs. 30.0%; p=0.009). In the multivariate analysis, preoperative hydronephrosis was determined as an independent prognostic marker for recurrence-free survival besides the pT classification and lymph node status (p=0.0015). The etiology of hydronephrosis did not affect the tumour-specific survival. CONCLUSIONS: Hydronephrosis at the time of diagnosis of bladder cancer is associated with a high probability of advanced tumours. It is an independent prognostic factor for recurrence-free survival.

Adult↗

PubMed2002

Nonoperative management of neonatal moderate to severe bilateral hydronephrosis.

PURPOSE: The natural history of prenatally diagnosed bilateral ureteropelvic junction hydronephrosis is unknown. No definite recommendations exist regarding management, and many authors recommend unilateral or bilateral pyeloplasty. We present the results of nonoperative management of bilateral hydronephrosis. MATERIALS AND METHODS: A total of 16 patients (32 kidneys) with prenatally diagnosed moderate to severe bilateral hydronephrosis were followed nonoperatively. Pyeloplasty was performed only for evidence of deterioration of function and only unilateral surgery was performed when necessary. RESULTS: Of the 32 kidneys 31 had moderate or severe hydronephrosis and 4 (12.5%) required pyeloplasty during a mean followup of 36 months. Hydronephrosis spontaneously resolved or improved in 78% of those observed nonoperatively. Of the 25 kidneys followed nonoperatively for at least 2 years 80% demonstrated improvement. While initial drainage half-time was more than 20 minutes in 55% of kidneys, 78% of unoperated kidneys had a final half-time of less than 20 minutes. Of the 10 kidneys with bilateral severe hydronephrosis 3 (30%) required pyeloplasty. All children had normal glomerular filtration rate for age at the latest followup. Only 1 child has persistent bilateral severe hydronephrosis at age 1 year. CONCLUSIONS: Initial nonoperative observation appears to be safe in all cases of moderate to severe bilateral neonatal hydronephrosis. Spontaneous improvement can be expected in most kidneys by 2 years. Only a few children require unilateral pyeloplasty and bilateral operation can be avoided in most cases.

Drainage↗

PubMed2003

CT detection of hydronephrosis in resected colorectal cancer: a predictor of recurrent disease.

AIM: To investigate the causes and significance of hydronephrosis in follow-up of colorectal cancer. METHODS AND MATERIALS: Case notes and serial computed tomography (CT) examinations were reviewed of 75 patients (250 CT examinations) after resection for colorectal cancer in whom hydronephrosis developed on follow-up. RESULTS: The most common cause of hydronephrosis was a focal plaque-like mass centred on the peritoneum, demonstrated in 37 cases (49%). Patients with R1 (microscopic residual tumour) or R2 (macroscopic residual tumour) disease developed hydronephrosis at a median time of 13 months (90% CI: 9-18 months) compared with 22 months (90% CI: 17-26 months) for those having (R0) curative resection. Patients with pT4 invasion of peritoneum or adjacent organs developed hydronephrosis at a median of 14 months (90% CI: 6-16 months) compared with a median of 22 months in patients with pT3 tumours (90% CI: 11-27 months). Of 26 patients without an obvious cause of hydronephrosis on initial CT examination, follow-up CT demonstrated a definite mass lesion in 50%. Median survival after the onset of hydronephrosis was 6 months (range 1-34 months) with a 1-year mortality of 62%. CONCLUSIONS: Hydronephrosis is an important early indicator of colorectal cancer recurrence, even in the absence of a mass.

Adult↗

PubMed2000

The long-term followup of newborns with severe unilateral hydronephrosis initially treated nonoperatively.

PURPOSE: During the last decade it has become apparent that prenatally detected, unilateral severe hydronephrosis does not necessarily represent obstruction and may spontaneously improve or resolve postnatally. To define its natural history better we performed a long-term (mean 78 months) followup study of infants with hydronephrosis. MATERIALS AND METHODS: A total of 104 newborns with antenatally diagnosed, primary, unilateral severe hydronephrosis were followed nonoperatively unless evidence of renal deterioration occurred for which pyeloplasty was performed. RESULTS: All 23 infants (22%) who required pyeloplasty were younger than 18 months and had progressive hydronephrosis and/or reduction in differential renal function. Differential function exceeded predeterioration levels in all kidneys postoperatively. Of those cases followed nonoperatively hydronephrosis resolved in 69% and improved in 31%. Mean time to maximum improvement of hydronephrosis was 2.5 years. In 76% of those cases followed nonoperatively initial differential function was greater than 40% and final function averaged 49%. In the remaining 24% of cases differential function was less than 40% (mean 23%), and in an average of 18 months differential function increased to a mean of 47%. Initial half-time in nonoperative cases was greater than 30 minutes in 37%, 20 to 30 in 21% and less than 20 in 42%. Final half-time was greater than 30 minutes in 16%, 20 to 30 in 17% and less than 20 in 67%. Half-time was greater than 30 minutes in 87% of the patients and 20 to 30 in 4% before, and greater than 30 in 10%, 20 to 30 in 27% and less than 20 in 63% after pyeloplasty. CONCLUSIONS: Unilateral newborn hydronephrosis appears to be relatively benign and in most instances dilatation and renal function improve with time. However, close followup is necessary to identify the subgroup of less than 25% of infants with obstruction because prompt pyeloplasty will prevent permanent loss of renal function. Standard tests for assessing obstruction in older patients appear to be invalid in infants because prolonged half-time and/or high grade hydronephrosis is neither an indicator of obstruction or surgery. Nonoperative treatment with close followup especially during the first 2 years is safe and recommended for these children.

Disease Progression↗

PubMed1994

[Clinical examination and therapies of hydronephrosis after radical hysterectomy].

We investigated postoperative hydronephrosis in 50 patients (100 ureter) undergoing radical hysterectomy for uterine cervical cancer from Jan. 1989 to Dec. 1991 at Department of Obstetrics and Gynecology in Nagasaki University Hospital. The incidence of hydronephrosis was 68.1% of patients, and hydronephrosis was seen significantly more frequently and was of a higher grade on the right kidney than the left. After one year, hydronephrosis disappeared in 59.1% of patients (65.1% of right kidney, 88.2% of left kidney), and only 2 of 93 kidney have worsened. In cases without hydronephrosis, hydronephrosis developed in only 3 of 31 kidney after one year due to local recurrence or nodule metastasis of the original disease. We compared therapeutic effects of 3 methods (ureteral stent, PNS, no treatment). But there was no significant difference between these methods, we could not determine which was the best treatment. And we observed that indwelling ureteral stent might interrupt spontaneous healing of ureter. Radiotherapy didn't significant influence hydronephrosis after radical hysterectomy; Therefore, we suggest that, in patients with hydronephrosis without other severe urological complications after radical hysterectomy, clinical course should be observed for at least one year, first and them some treatments should be applied if cases worsen gradually than before.

Adult↗

PubMed1997

[A study of the indication for conservative surgery in adult hydronephrosis based on presurgery post-contrast computed tomography (CT) finding].

BACKGROUND AND OBJECT: The cases with adult hydronephrosis are usually performed either conservative surgery or nephrectomy according to the grade of residual renal function. The residual renal function of adult hydronephrosis are usually suspected with analysis of concentration and/or clearance of the renal urine content after percutaneous nephrostomy. However, percutaneous nephrostomy is invasive and risky. On the other hand, post-contrast computed tomography (CT) is non-invasive. We studied whether post-contrast CT is available for the assessment of residual renal function of adult hydronephrosis and also studied the indication for conservative surgery of adult hydronephrosis on post-contrast CT. MATERIALS AND METHODS: Conservative surgery or nephrectomy was performed in 14 patients with adult hydronephrosis in the duration from April, 1986 to March, 1995. All of 14 patients (14 kidneys) hydronephrosis were retrospectively studied of the character in the indication for conservative surgery by post-contrast CT before surgery. RESULTS: The indication for conservative surgery of adult hydronephrosis on post-contrast CT are (1) well enhanced renal parenchyma exist round the kidney, even if it is very thin, and (2) excretion of contrast medium to renal calyx are showed. CONCLUSION: It was concluded that post-contrast CT might be useful for the assessment of residual renal function of adult hydronephrosis.

Adolescent↗

PubMed2002

Outcome of prenatally diagnosed fetal hydronephrosis.

OBJECTIVE: To demonstrate the postnatal investigation, treatment and outcome of infants with hydronephrosis prenatally diagnosed by ultrasound between 1994 and 1996. STUDY DESIGN: In a two-year period we studied 20 infants who presented with hydronephrosis diagnosed by prenatal ultrasound and confirmed by postnatal ultrasound. Unilateral hydronephrosis was diagnosed in 17 infants and bilateral hydronephrosis in 3. An anteroposterior renal pelvic diameter > 7 mm after 33 weeks of pregnancy was used to predict abnormal outcomes. In the postnatal follow-up period, the infants were followed with sequential ultrasound and urinalysis. 99mTc-diethylene triamine pentaacetic acid scan, intravenous pyelography and voiding cystourethrography were performed in selected cases. Pyeloplasty was performed only if there was evidence of renal compromise. RESULTS: A male predilection was found. The left kidney was more commonly involved. Ultrasonic follow-up of the 20 infants showed that hydronephrosis resolved in 9, who were all in the unilateral hydronephrosis group. The range of fetal renal pelves on prenatal ultrasound was 7-15 mm in the resolution group. Pyeloplasty was performed in three unilateral hydronephrosis infants. Follow-up ranged from 36 to 72 months. CONCLUSION: When the fetal renal pelvis was < 15 mm on prenatal ultrasound, it never progressed. Prenatally diagnosed hydronephrosis may be safely observed, and surgical correction should be performed only if renal compromise occurs.

Female↗