Hydronephrosis

Question 1

What are the causes of unilateral hydronephrosis?

Answer 1

PACT

Pelvic-ureteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of renal pelvis

Question 2

What are the causes of bilateral hydronephrosis?

Answer 2

SUPER

Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis

Question 3

What are the investigations for hydronephrosis?

Answer 3

Ultrasound - first-line: identifies presence of hydronephrosis and can assess the kidneys

IVU (Intravenous urogram) - assess position of the obstruction

Antegrade or retrograde pyelograpy - allows treatment

If suspecting renal colic: CT scan (majority of stones detected this way)

Question 4

What is the management of hydronephrosis?

Answer 4

Remove the obstruction and drainage of urine
Acute upper urinary tract obstruction: nephrostomy tube
Chronic upper urinary tract obstruction: ureteric stent or a pyeloplasty