becauseurinary systemCaused by obstruction ofRenal pelvisAndCaliceal dilatationRetention of urine is called hydronephrosis.Because of the accumulation of urine in the kidney, the pressure rises, which makes the renal pelvis andRenal calyxExpansion andRenal parenchymaAtrophy.If the retained urine is infected, it is calledInfectivityHydronephrosis;When the renal tissue becomes necrotic due to infection and loses its function, the renal pelvis becomes fullPurulent fluid, calledPyonephrosisorPyonephrosis。The main cause of hydronephrosis is the renal pelvisureterObstruction at the junction.
Foreign name
hydronephrosis
Visiting department
Department of Nephrology
Common location
kidney
Common causes
Segmental nonfunction, intrinsic ureteral stricture, ureteral distortion, adhesion, band or valve pin structure, etc
common symptom
Abdominal mass and waist distension, accompanied by nausea, vomiting, abdominal distension, and oliguria
The causes of hydronephrosis are congenital and acquired, andUrinary systemExternally andLower urinary tractHydronephrosis due to etiology.
Congenital obstructive etiology
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Segmental non function:The normal peristalsis of this segment of ureter is affected due to the segmental muscular absence, hypoplasia or anatomical structure disorder at the junction of the renal pelvis and ureter or the upper segment of ureter, resulting in dynamic obstruction.If this kind of disease occurs at the entrance of ureter and bladder, it will form congenital megaureter, with the consequence of kidney and ureter dilatation and hydronephrosis.
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Intrinsic ureteral stricture:Most of them occur at the junction of pelvis and ureter. The narrow segment is usually 1~2mm, or 1~3cm long, resulting in incomplete obstruction and secondary distortion.Under the electron microscope, we can see that there are too many collagen fibers around and in the middle of the muscle cells in the obstructed section. After a long time, the muscle cells are damaged, forming an inelastic narrow section dominated by collagen fibers, which hinders the transmission of urine and forms hydronephrosis.
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Torsion, adhesion, band or valve pin structure of ureter:This can be either congenital or acquired. It often occurs at the junction of the renal pelvis and ureter, the lumbar segment of the ureter. Children and infants account for almost 2/3.
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Heterotopic vascular compression:It is located in the front of the junction of the renal pelvis and ureter. Others include horseshoe shaped kidney and kidney rotation obstruction during embryonic development.
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High ureteral opening:It can be congenital or asymptomatic dilatation of the renal pelvis caused by peripelvic fibrosis or vesicoureteral reflux, resulting in relatively upward migration of the junction of the renal pelvis and ureter, and no stenosis can be found during the operation.
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other:Congenital ectopic ureter, cyst, double ureter, etc.
Acquired obstruction
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Inflammatory or ischemic scars lead to local fixation.
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The ureter distortion caused by vesicoureteral reflux, together with the fibrosis around the ureter, eventually forms obstruction at the junction of the renal pelvis and ureter or ureter.
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Neoplasms such as tumors and polyps of the renal pelvis and ureter may be primary or metastatic.
Patients often have no symptoms for a long time until they appearAbdominal massAnd lumbar distension.Most of the lumps are found unintentionally and are generally cystic.The pain is generally mild, or even completely painless.But inIntermittent hydronephrosisCase (due to ectopic vascular compression orNephroptosisMay occurRenal colic, the pain is severe, radiating along the costal margin and ureter.Often accompanied by nausea, vomitingabdominal distention, low urine.It usually relieves in a short time or several hours, and then a large amount of urine is discharged.Enlarged kidneys can be touched during examination.IfGiant hydronephrosisThe tension may not be great.
If hydronephrosis is complicated with infectionPyuriaAnd systemic poisoning symptoms, such asshiver、fever、headacheas well asGastrointestinal disorders。Some patientsurinary tract infectionAs the initial symptom, patients with poor treatment effect of urinary tract infection must pay attention to the presence of obstructive factors.In case of severe obstruction, inflammatory exudates cannot be discharged through urine, and there is nowhite blood cell, but in this caseLocal painAnd tenderness are more obvious.
The swollen hydronephrosis is more susceptible to trauma, and slight injury may cause rupture and bleeding.Urine inflowRetroperitoneal spaceorPeritoneal cavityIt causes serious reactions, including pain, tenderness and systemic symptoms.
inspect
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B-ultrasonic inspection:B-ultrasonic examination is simple and harmless, which is helpful to make a clear diagnosis.It can also show the shape of the remaining kidney tissue of hydronephrosis, and is helpful to understand the condition of urinary tract (renal pelvis, calyces, and proximal ureter of obstruction).
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Diuretic renogram:Diuretic renogram is an important examination in the diagnosis of hydronephrosis in recent years.It is helpful to identify the early pathological changes (whether there is hydronephrosis), determine whether hydronephrosis needs surgical treatment and the status of renal function damage.In particular, single kidney hydronephrosis is relatively light, or double kidney hydronephrosis is serious on one side and light on the other side. It is more valuable whether surgery is needed for light hydronephrosis.Diuretic renogram can also be used to monitor the functional recovery after surgery (pyeloplasty).
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Measurement of renal pelvis flow pressure:It is also one of the valuable examination methods clinically in recent years, and its significance is similar to that of diuretic renogram.
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Urography and other examinations:It is very important to estimate the function of hydronephrosis.It is of great significance for whether the operation needs to be performed, the mode of operation and the chance of postoperative renal function recovery.
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Imaging examination:If the thickness of the remaining renal parenchyma of hydronephrosis exceeds 1.5 cm, the kidney is valuable for preservation.
diagnosis
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According to the clinical manifestation and the location, time, speed and presence of obstructionSecondary infectionAnd the nature and examination of the primary lesion.
treatment
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Surgical treatment of hydronephrosis should be carried out early.Reasonable applicationplastic operationCorrect the abnormality of the ureteropelvic junction and strive for greater recovery of renal function.If the hydronephrosis is serious and the renal function is severely damaged, and the opposite kidney is normal, hydronephrosis can be treated as hydronephrosisNephrectomy。
The principle of operation is that the obstruction is slight,Dilation of renal pelvis and calycesIf not serious, simple orthopedic operation shall be performed;If the dilatation is obvious, the narrow segment of the lesion and the excessively dilated renal pelvis should be removed, and thenanastomosis；In more serious cases, nephrectomy was performed.
The treatment of hydronephrosis should be more careful, and the kidneys should be preserved as much as possible.Generally, there are several situations:
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Severe hydronephrosis on one side:One side is lighter: the severe side can be treated first.In order to avoid renal insufficiency, a successful operation can increase the safety of contralateral operation.The indication of operation should be carefully determined for the lighter side, and close observation can be made if necessary.
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Severe hydronephrosis on both sides:It can be treated by stages, but it is better to treat the heavier side first.
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Light hydronephrosis on both sides:Careful analysis is needed to determine the surgical indications.
