July 29th, 2015
A condition where obstruction of the urine outflow distal to renal pelvis results in distension of renal pelvis and calyces with urine is called as hydronephrosis. Similarly, when the obstruction is beyond the ureters, there is swelling of the ureters with urine, a condition known as hydroureter in medical parlance. Both these conditions can be unilateral or bilateral, acute or chronic and physiological or pathological.
The common causes of hydronephrosis and hydroureter are:
The symptoms depend upon whether the condition develops suddenly or is chronic in nature.
In case of acute obstruction, the distension caused by urine may lead to severe pain. This can be seen in sudden complete obstruction caused by ureteric calculi or in case of fluid overload which leads to increased urine output as compared to the rate of urine outflow through an area of obstruction.
In case of a slowly developing obstruction or when the obstruction is partial as seen in the cases of pelvic tumors or congenital stricture at the ureteropelvic junction, the pain may be completely absent.
The pain also depends upon the site of obstruction. When the obstruction is at the level of kidneys or upper ureters, the patient complains of pain in his flanks. However, when the obstruction is at the level of lower ureters or the bladder, the patient complains of pain that radiates to the groin region.
The patient may present with anuria in case of sudden complete bilateral obstruction.
Hematuria may be present in case of calculi or malignancy.
Medical treatment is usually limited to control of pain and infection. Alkalis may be given to treat uric acid stones and steroids may be given for retroperitoneal fibrosis.
Surgical treatment is the mainstay and depends upon the cause and site of obstruction. Early intervention is desirable to prevent long term damage to the kidneys.
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