Patient's question:
NoDoctor's answer:
What is hydronephrosis? The urinary system is a continuous pipeline system starting from the kidneys and extending to the urethral orifice. The excretion of urine depends on the patency of the urinary tract and normal urination function. Any narrowing or obstruction of the urinary tract at any location, as well as dysfunction of the normal function of nerves and muscles, ultimately leads to hydronephrosis, expansion of the kidneys, thinning of renal parenchyma, and decline in renal function. If bilateral obstruction occurs, it may result in uremia, with severe consequences.What causes hydronephrosis? The causes of urinary obstruction leading to hydronephrosis are numerous and can be congenital, such as stenosis at the renal pelvis-ureteral junction, urethral valves, or horseshoe kidneys, as well as acquired diseases like stones, tumors, benign prostatic hyperplasia, or bladder neck contracture. It can also be caused by external compression from fibrous bands or tumors, such as retroperitoneal fibrosis or lymphoma. Additionally, it may result from urinary tract neuro-muscular disorders, such as megaureter. Obstruction can be acute or chronic. Acute obstruction may cause complete loss of renal function in a short period, while hydronephrosis may not be very apparent. Chronic obstruction can lead to hydronephrosis exceeding 1,000 milliliters.
If hydronephrosis is complicated by infection, if the obstruction is not promptly relieved, the infection will be difficult to treat. The infection accelerates kidney damage, creating a vicious cycle, and may even lead to suppurative nephritis.
What are the symptoms of hydronephrosis?
1. Symptoms of the primary disease, such as pain from stones, hematuria from tumors, or difficulty urinating from urethral stricture.
2. Swelling and pain in the affected flank.
3. Fever, chills, and purulent urine if infection occurs.
4. A cystic mass in the affected flank.
5. Chronic renal insufficiency and uremia if bilateral obstruction occurs.
What tests are needed for hydronephrosis?
1. Flank pain and cystic masses in the flank.
2. Ultrasound: Enlarged kidney size, thinning of the cortex, and variable-sized fluid-filled areas in the.
3. Intravenous pyelography showing hydronephrosis.
4. Isotope renography, obstruction-type renogram.
5. Retrograde ureteral catheterization showing hydronephrosis.
How is hydronephrosis treated?
1. Remove the cause and relieve the obstruction.
2. If the condition is too severe or the cause is complex, percutaneous nephrostomy can be performed for initial drainage.
3. In severe hydronephrosis or suppurative nephritis, if the contralateral kidney function is good, nephrectomy may be performed.
4. For patients who cannot undergo surgery, bilateral "T" tubes or stents may be placed.
5. The purpose of medication is primarily to prevent and control infection before and after surgery. Whenever possible, use drugs that do not harm or minimally harm renal function.
Hydronephrosis is caused by the narrowing or obstruction of the urinary tract at any location or dysfunction of the normal function of nerves and muscles. The symptoms of this disease include flank pain and difficulty urinating, as well as edema in the limbs and face. According to doctors, the severity of the disease can vary, depending on the extent of hydronephrosis. If treated properly, recovery is usually rapid. Otherwise, it may lead to complications such as uremia or kidney failure, which can be life-threatening.
Hydronephrosis (Hydroephrosis) refers to the obstruction of urine excretion from the kidneys when the urinary tract is blocked, causing urine to accumulate in the kidneys. Over time, the renal pelvis expands, leading to hydronephrosis. Severe hydronephrosis can cause increased pressure in the renal pelvis and calyces, which affects the filtration function of the glomeruli, impairs kidney function, and gradually compresses and atrophies the renal parenchyma. The causes of urinary tract obstruction leading to hydronephrosis are numerous, such as congenital stenosis at the renal pelvis-ureteral junction, ureteral stones, tuberculous bladders, benign prostatic hyperplasia, or urethral stricture.
Due to urine retention, hydronephrosis is prone to secondary bacterial infection. Hydronephrosis is generally not curable with medication, but to prevent secondary infection and protect renal function, the following measures can be taken before the urinary tract obstruction is relieved:
① Antibacterial drugs, such as erythromycin or cephalosporins.
② Traditional Chinese medicine treatment: Use antibacterial herbs that clear heat and resolve toxicity, such as bupleurum, phellodendron, baical root, and plantain.
Dietary care
① Increase energy intake, but avoid excessive consumption of protein-rich foods to prevent burdening the hydronephrotic kidney. Energy intake mainly relies on carbohydrates and fat-rich foods.
② If hydronephrosis is unilateral, there is no need to limit fluid intake. If bilateral hydronephrosis is present with kidney dysfunction, daily fluid intake should be restricted.
Surgery: The choice of treatment depends on the cause, onset, presence of infection, degree of renal function impairment, as well as the patient's age and cardiopulmonary function.
1. Etiological treatment: The ideal treatment is to remove the cause of hydronephrosis while preserving the affected kidney. If the obstruction has not yet caused severe, irreversible damage, good results can be achieved after removing the cause. The surgical method depends on the nature of the cause. For example, congenital stenosis at the renal pelvis-ureteral junction can be treated with pyeloplasty, and ureteral stones can be treated with lithotripsy or stone removal. These surgeries can now be performed using endoscopy. Postoperative hydronephrosis and renal function may improve.
2. Nephrostomy: If the condition is urgent or the cause of hydronephrosis cannot be removed, drainage should be performed above the obstruction first, and then surgery to remove the cause should be carried out after infection is controlled. If the obstruction cannot be relieved, nephrostomy may serve as a permanent treatment.
3. Nephrectomy: If hydronephrosis is severe, the remaining renal parenchyma is insufficient, or there is severe infection (suppurative nephritis), and the contralateral kidney function is good, the affected kidney can be removed.
(1) Overview
Hydronephrosis is defined as obstruction of urine excretion from the renal pelvis, leading to increased intrarenal pressure, expansion of the renal pelvis and calyces, and atrophy of the renal parenchyma.
(2) Clinical manifestations
Urinary tract obstruction caused by various lesions in the urinary system and its surrounding areas can ultimately lead to hydronephrosis. Due to differences in the cause, location, and degree of obstruction, the clinical manifestations and progression of hydronephrosis vary among patients. Hydronephrosis caused by congenital lesions, such as stenosis at the renal pelvis-ureteral junction, ectopic renal vessels, or fibrous bands compressing the ureter, develops slowly and may remain asymptomatic for a long time, only presenting with an abdominal mass when it reaches a certain size. Secondary hydronephrosis caused by stones, tumors, inflammation, or tuberculosis in the urinary system primarily manifests the symptoms and signs of the primary disease, with hydronephrosis rarely being the main clinical feature. It is often discovered during acute complete obstruction, such as renal colic when a kidney and ureteral stone becomes lodged. Secondary hydronephrosis with infection often exacerbates the symptoms of the primary disease. Hydronephrosis may be intermittent, referred to as intermittent hydronephrosis. During an attack, severe abdominal pain, nausea, vomiting, and decreased urine output occur. After several hours or longer, the pain subsides, followed by the passage of a large amount of urine. This is more common in ureteral obstruction. Chronic obstruction leading to hydronephrosis will eventually result in gradual decline in renal function. Complete obstruction of both kidneys or an isolated kidney may lead to anuria and renal failure. It should be noted that mild hydronephrosis of the kidneys and ureters is common during normal pregnancy. In addition to pressure from the pregnant uterus on the ureters, it is also caused by the relaxation of the renal pelvis-ureteral muscles due to progesterone secretion during pregnancy. This type of hydronephrosis is a physiological state and almost always occurs on the right side due to anatomical relationships.
(2) Diagnosis
First, it is necessary to confirm the presence of hydronephrosis, then identify the cause, location, degree, presence of infection, and extent of renal function impairment. In the differential diagnosis of abdominal masses, hydronephrosis should be considered. The tension of hydronephrotic masses may vary. If the mass is less tense or hard and soft with fluctuation, hydronephrosis is highly likely. Some secondary hydronephrosis, where the symptoms of the primary disease are prominent, such as tuberculosis or tumors, may be easily overlooked. Obstruction of the urinary system caused by lesions near the urinary tract and subsequent hydronephrosis are often not diagnosed in time, and may only be discovered when renal failure or anuria occurs.
Laboratory tests should include blood tests to assess for azotemia, acidosis, and electrolyte disorders. Urinalysis should include routine tests and cultures, with tuberculosis and shed cells examined when necessary. Intravenous pyelography is of great value in diagnosis. One typical finding of excretory pyelography is prolonged renal parenchymal contrast filling time. Due to reduced glomerular filtration rate, slow urine flow in the renal tubules, and increased water reabsorption, contrast medium accumulates in the renal cortex, primarily in the proximal tubules, making the renal image clearer. Therefore, a dense renal shadow is a characteristic feature of acute obstruction. Delayed excretory pyelography with a higher dose can be more helpful in diagnosing hydronephrosis; the contrast dose can be increased 2–3 times, and the delay time can be extended to 24–36 hours. If excretory pyelography is not clear enough, retrograde pyelography can be performed via cystoscopy with ureteral catheterization. After the catheter is inserted into the renal pelvis, if hydronephrosis is present, a large amount of urine can be aspirated, and the contralateral renal function can be assessed. If retrograde catheterization is difficult, renal puncture contrastography can be performed. During retrograde and puncture contrastography, care must be taken to prevent bacteria from entering the hydronephrotic kidney. Ultrasound, CT, and MRI can clearly distinguish between hydronephrosis and solid masses in the enlarged kidney and can also identify lesions compressing the urinary system. Since ultrasound is widely available and non-invasive, it can be performed before intravenous pyelography. Nuclear medicine scans and renography can also be used for the diagnosis of hydronephrosis. In dynamic obstruction cases, the movement and emptying of the renal pelvis and ureters can be observed during intravenous pyelography. Neurogenic bladder may appear as a "pyramid" on cystography, with trabeculations and pseudodiverticula.
(3) Treatment
Treatment should be based on the cause, onset, presence of infection, degree of renal function impairment, as well as the patient's age and cardiopulmonary function.
1. Etiological treatment: The ideal treatment is to remove the cause of hydronephrosis while preserving the affected kidney. If the obstruction has not yet caused severe, irreversible damage, good results can be achieved after removing the cause. The surgical method depends on the nature of the cause. For example, congenital stenosis at the renal pelvis-ureteral junction can be treated with pyeloplasty, and ureteral stones can be treated with lithotripsy or stone removal. These surgeries can now be performed using endoscopy. Postoperative hydronephrosis and renal function may improve.
2. Nephrostomy: If the condition is urgent or the cause of hydronephrosis cannot be removed, drainage should be performed above the obstruction first, and then surgery to remove the cause should be carried out after infection is controlled. If the obstruction cannot be relieved, nephrostomy may serve as a permanent treatment.
3. Nephrectomy: If hydronephrosis is severe, the remaining renal parenchyma is insufficient, or there is severe infection (suppurative nephritis), and the contralateral kidney function is good, the affected kidney can be removed.
(4) Nursing
Postoperative nursing issues for hydronephrosis patients:
1. Ureteral leakage-related factors: Related to surgery. Nursing measures:
(1) Flush the renal pelvis drainage tube with 10 mL of metronidazole twice daily.
(2) Irradiate the wound with TDP for 30 minutes once daily.
(3) Record the urine output of the left kidney and the amount of wound drainage.
(4) Notify the doctor promptly if the dressing becomes wet.
(5) Maintain unobstructed drainage and properly secure the drainage tube to prevent compression, folding, or twisting.
2. Infection-related factors: Related to surgical trauma and indwelling catheters. Nursing measures:
(1) Use antibiotics as prescribed.
(2) Measure body temperature four times daily.
(3) Clean the urethral orifice with 0.1% new twice daily and change the drainage bag daily.
(4) Maintain unobstructed drainage and strictly follow sterile procedures.
(5) After flatus, encourage the patient to drink more fluids (at least 3,000 mL daily) and consume nutrient-rich foods.
3. Pain-related factors: Related to surgical trauma. Nursing measures:
(1) Comfort the patient and help them relax.
(2) Guide the patient and family to use the pain pump correctly, protect the painful area, and master methods to reduce pain.
(3) Administer analgesics as prescribed and observe and record the effects after medication.
(4) Adjust a comfortable position.
4. Risk of skin damage: Related to postoperative bed rest. Nursing measures:
(1) Explain the importance of maintaining skin integrity to the patient and family, gain their cooperation, and explain skin care methods and risk factors for skin damage.
(2) Assist the patient in changing positions in a timely and orderly manner and massage the bony prominences.
(3) Keep clothing, bedding soft, flat, dry, and free of debris.
(4) Guide the patient in bed mobility techniques and develop a bed mobility plan.
5. Constipation-related factors: Related to bed rest. Nursing measures:
(1) Encourage the patient to increase bed mobility.
(2) Eat more vegetables, fruits, and other high-fiber foods and drink plenty of fluids.
(3) Provide physical assistance for defecation if the patient has difficulty.
(4) Guide the patient in developing good bowel habits.