HYDRONEPHROSIS Flashcards
U/L HYDRONEPHROSIS: CAUSES
π§ β‘PACT-U β‘
- PUJ obstruction
β¨ Congenital
β¨ Acquired - Aberrent Renal Vessels
- Calculi (Renal Stones)
- Transitional Cell Cancer of Renal Pelvis
- Tumours of Renal Pelvis
- Ureterocele
β‘β‘ MOST COMMON CAUSE of ACQUIRED HYDRONEPHROSIS
Renal Stones
β‘β‘ MOST COMMON CONGENITAL CAUSE OF U/L HYDRONEPHROSIS
PUJ OBSTRUCTION
U/L HYDRONEPHROSIS: INTRALUMINAL CAUSES
- Stones
- Sloughed papilla (Papillary Necrosis)
U/L HYDRONEPHROSIS: INTRAMURAL CAUSES (Inside wall)
- PUJ Obstruction
- Ureterocele
- Inflammatory STRICTURES
- NEOPLASMS
β¨ Ureter
β¨ Bladder Cancer
U/L HYDRONEPHROSIS: EXTRA-LUMINAL CAUSES
- Aberrant RENAL VESSELS
- Advanced Cancers from adjacent sites:
β¨ Retroperitoneal Soft Tissue Sarcoma
β¨ Uterine Cancer
β¨ Ca CERVIX
β¨ CA COLON
β¨ CA PROSTATE
β¨ CA RECTUM - Retrocaval Ureter
- Retroperitoneal Fibrosis
π©Ί IOC for PUJ Obstruction
MAG3 Scan
ππ MANAGEMENT of SYMPTOMATIC PUJ OBSTRUCTION
Anderson Hynes Dismembered Pyeloplasty
Ureterocele meaning
Dilatation of TERMINAL ENDS of Ureter
ππ MANAGEMENT of Ureterocele
- Excision of Terminal End & Re-implantation of URETER
- Endoscopic Surgery
ππ MANAGEMENT of Aberrant Renal Vessels
Extra Renal Artery
β NEVER CUT ABERRENT VESSELS
PYELOPLASTY
Identify B
Retrocaval URETER
β¬οΈ
Right sided URETER goes behind the IVC
IVC will compress the ureter
β¬οΈ
U/L HYDRONEPHROSIS
ππ MANAGEMENT of RETROCAVAL URETER
- LATERALIZATION of URETER
β¬οΈ if fails - Resection & Anastamosis (URETERO-URETEROSTOMY)
Causes of B/L HYDRONEPHROSIS
π§ β‘SUPΒ²ER β‘
- Stenosis: URETHRA
- Urethral Valve: PUV
- Prostatic ENLARGEMENT (BPH, Ca Prostate)
- Phimosis
- Extensive Bladder TUMOUR
- Retroperitoneal Fibrosis
Ormondβs DISEASE
Synonyms of RETROPERITONEAL FIBROSIS
Causes of RETROPERITONEAL FIBROSIS
π§ β‘DSLAβ‘
- Drugs
β¨ Methysergide
β¨ Bromocriptine
β¨ Methyl DOPA
β¨ Beta blockers - SMOKING
- LYMPHOMA
- AUTOIMMUNE: IgG4 Related Disorders
- Post Radiotherapy
1st STRUCTURE TO BE INVOLVED IN RETROPERITONEAL FIBROSIS
URETER
β In RETROPERITONEAL FIBROSIS, BOTH URETERS _____________
β In SOFT TISSUE SRACOMA, BOTH URETERS _____________
β In RETROPERITONEAL FIBROSIS, BOTH URETERS _____________
π― COMES CLOSE TO EACH OTHER
β In SOFT TISSUE SRACOMA, BOTH URETERS _____________
π― DIVERGE FROM EACH OTHER
ππ MANAGEMENT of HYDRONEPHROSIS in RETROPERITONEAL FIBROSIS
β¨ Double J stent (DJ STENT)
β¨ Steroids
β¨ ππ MANAGEMENT of 1Β° CAUSE
Hy
Renal ISOTOPE SCANS
- DMSA
- DTPA
- MAG3
DMSA SCAN helps to assess
π§ β‘S β‘
Scarring & Structure of Kidney
Function of the KIDNEY can be determined by which isotope scans
- DTPA
- MAG3 (BEST)
FINDINGS of MAG3 SCAN
- Total GFR
- Differential GFR (GFR of each KIDNEY)
ππ MANAGEMENT of HYDRONEPHROSIS
β Hydronephrotic Kidney contributes > 20% to TOTAL GFR
β Hydronephrotic Kidney contributes 10-20% to TOTAL GFR
β Hydronephrotic Kidney contributes < 10% to TOTAL GFR
β Hydronephrotic Kidney contributes > 20% to TOTAL GFR
π― SAVE THE KIDNEY: Manage 1Β° Abnormalities
β Hydronephrotic Kidney contributes 10-20% to TOTAL GFR
π― NEPHROSTOMY
β¬οΈ
β¨ If Function IMPROVES β‘οΈ SAVE Kidney
β¨ If Function does not IMPROVES β‘οΈ NEPHRECTOMY
β Hydronephrotic Kidney contributes < 10% to TOTAL GFR
π― NEPHRECTOMY
ππ MANAGEMENT of HYDRONEPHROSIS
β Hydronephrotic Kidney contributes > 20% to TOTAL GFR
π― SAVE THE KIDNEY: Manage 1Β° Abnormalities
Identify
NEPHROSTOMY
β¬οΈ
Artificial opening created between the kidney and the skin which allows for the urinary diversion directly from the upper part of the urinary system
VESICOURETERIC REFLUX (VUR)
Gender predominance
β < 3 months: βοΈ > βοΈ
β > 3 months: βοΈ > βοΈ
π©Ί IOC for VUR
MCU (MICTURATING CYSTOURETHROGRAM)
Grading of VUR
π§ β‘NUDGE β‘
π§π»ββοΈ Clinical Features of VUR
RECURRENT UTI
β
Pain
Fever
Renal Scarring
COMPLICATIONS of VUR
- Chronic Pyelonephritis
- Hypertension
ππ MANAGEMENT of VUR
HIT & STING PROCEDURES are used for
Endoscopic MANAGEMENT OF VUR
Lead Better Politano Technique used for
Ureter REIMPLANTATION