Hydronephrosis

Hydronephrosis refers to the swelling of one or both of the kidneys that occurs due to accumulation of urine in it. The urine goes through the ureter and is excreted by the urethra. If the outward flow of urine is blocked for some reason, it passes back to the kidneys, causing pressure and swelling. This condition is called as Hydronephrosis. It is not a disease in itself but occurs due to other underlying conditions. Reasons such as obstruction in urinary flow, kidney stones, reflux of urine from bladder to kidney lead to Hydronephrosis.

Symptoms of Hydronephrosis

• Sudden or intense pain in the back or sides
  
  
• Dull pain in the groin area
  
  
• Nausea and Vomiting
  
  
• Reduced urine output
  
  
• Frequent or painful urination
  
  
• Blood in the urine
  
  
• Weakness or malaise
  
  
• Fever due to urinary tract infection
  

Causes of Hydronephrosis

• Urinary stone
  
  
• Blood clots in the kidney or ureter
  
  
• Kidney tumor or Tumors in the bladder, prostate gland
  
  
• Urinary scarring
  
  
• Renal enlargement
  
  
• Renal failure
  
  
• Uterine prolapse
  

Congenital Hydronephrosis

• Hydronephrosis can also occur in infants. Such congenital cases are noticed either at prenatal or antenatal stage.
  
  
• Hydronephrotic in infants is normally due to Vesico-ureteral reflux in which urine, instead of flowing from the kidneys to the bladder, abnormally flows back in the ureter.
  
  
• Another common cause is congenital Hydronephrosis obstruction either at uretero-pelvic junction or at ureter-bladder junction.
  
  
• The condition is also caused due to Ureterocele wherein the ureter does not develop properly and causes a small pouch into the bladder.
  
  
• Pregnant women also experience gestational Hydronephrosis due to mechanical compression of the ureter blocking the urine flow.
  

Diagnosis of Hydronephrosis

• Early diagnosis is very important; the longer hydronephrosis remains untreated, the more kidney function is lost.
  
  
• Diagnosis may begin by a thorough physical examination of the patient where the enlarged kidneys would be palpable due to swelling.
  
  
• After noting down the symptoms and the medical history of the patient, doctor may order few blood and urine tests to check the level of infection.
  
  
• Ultrasound scan is normally taken to confirm the diagnosis.
  
  
• Imaging tests like CT scan and MRI of abdomen and kidneys may be required to understand the underlying condition and the exact location of the blockage which helps in deciding the course of the treatment.
  

Hydronephrosis Treatment

• The first step in treating the condition would be to drain the accumulated urine through catheterization.
  
  
• Once the fluid is drained off, the underlying condition that resulted in Hydronephrosis needs to be addressed.
  
  
• If there is a blockage in the ureters, a stent can be placed to bypass the block for smooth flow of urine.
  
  
• Kidney stones are normally treated with lithotripsy, a shock wave treatment that fragments the stones into tiny pieces, to excrete easily.
  
  
• Enlarged prostate is treated with medication or surgery to remove part or whole of the prostate.
  
  
• If Hydronephrosis is caused due to kidney tumors, the same is treated with surgery, chemotherapy and radiation.
  
  
• Hydronephrosis in infants often resolves on its own and does not require any aggressive treatment except for some mild antibiotics to prevent infection.
  

Lithotripsy

Lithotripsy is a medical procedure wherein shock waves are used to break up kidney stones, ureter or bladder. Extra corporeal shock wave lithotripsy is the most commonly used type. The shock wave is termed extra corporeal as the shock wave is generated outside the body. It is a non-invasive technique. This procedure is used when the stone is too large to pass out on its own or if the stone is stuck in the ureter.

Lithotripsy Procedure

Prior to the treatment the following is followed:

• Complete physical examination
  
• Urine analysis
  
• Blood test
  
• IVP: intravenous pyelogram is used to locate the stone and understand the extent of blockage
  
• ECG for people with history of heart problems
  

Patient is made to lie down on a comfortable cushion/bed (usually water-filled). A mild sedative, pain killer and antibiotics are administered before the procedure so as to prevent any kind of discomfort, pain or infection. High energy sound waves pass through the body until they hit upon the kidney stone. The machine through which the waves is passed is called as the lithotripter. The kidney stone is broken into several pieces by the wave. The broken stone debris is called gravel. This gravel passes out while urinating. Usually there is no damage to skin or other internal organs as the shock waves are not focused on them. Generally after lithotripsy, people tend to bleed while urinating. This is common and will stop on its own. People who have undergone the procedure should drink plenty of water so as to flush the gravel out. A few patients may report abdominal pain which subsides on its own after a few days. If the symptoms persist, it is suggested that the patient visit the physician.

Lithotripsy should not be performed on people with skeletal deformities, persons with uncontrolled bleeding and pregnant women. Some of the possible side-effects include:

• Kidney infection
  
• Ulcers in the stomach or small intestine.
  
• Pieces of the stone may block free urine passage.
  
• Pieces of stone might be left behind in the body.
  
• Bleeding (internal)
  
• Very rarely stones do not get completely fragmented during the first time and so the procedure might have to be repeated again.
  

Ureteroscopy

Ureteroscopy is a common urological procedure administered in patients having urinary tract and bladder related disorders. Ureteroscopy is recommended for patients having kidney stones. The movement of the renal stones is monitored by urologists. Ureteroscopy is a minimal invasive endoscopic procedure predominantly involving the urethra, upper urinary tract and the urinary bladder.

Ureteroscopy Procedure

A flexible or rigid form of telescope is passed through the urethra in order to view the affected region. The procedure is performed under general or spinal anesthesia. The telescopic examination of the ureter and associated organs reveals the exact location of the stone and also other disorders of the system. Other diagnostic tests such as X-rays, CT scan, EKG along with laboratory parameters like urinalysis and complete blood count also help in the effective determination of the underlying condition. This technique is usually followed by the other associated procedures such as lithotripsy in which laser beams are administered to the affected region to dissolve the calculi(stone) or to clear urinary tract strictures. The entire procedure may last from 30 minutes to three hours and patients are advised to stay in the hospital for a day.

The urologist uses the uterescope to remove small kidney stones while larger stones need to be broken up before removal. A kidney stone that has escaped from the kidney and got stuck in the ureter can be pushed back into the kidney. Here it has to be broken into smaller pieces to aid removal. A stent is usually left in place to allow the kidneys to pass the urine to the bladder. This is kept for a few days in case there is swelling and subsequent difficulty in draining the kidney of the urine.

Complications and risk factors

Hematuria happens because of the insertion of the ureteroscope. It usually subsides within 3 days. Antimicrobial therapy is given if hematuria is followed by an infection. Other possible complications are:

Stent associated pain
Perforations caused because of stents
Abdominal pain
Lower back pain
Urethral stricture or perforation