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Clinical Study of Unilateral Or Bilateral Noncalculus Hydronephrosis and Or Hydroureter

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Clinical Study of Unilateral Or Bilateral Noncalculus Hydronephrosis and Or Hydroureter International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 10, Issue 3, 2014 pp 438-446 Clinical Study of Unilateral or Bilateral Noncalculus Hydronephrosis and or Hydroureter 1 2 3* Kasabe P. , R. D. Jaykar , Rahul Wagh {1Assistant Professor,2 Associate Professor, 3 Resident} Department of General Surgery, Dr. V. M. Govt. Medical College, Solapur, Maharashtra, INDIA. *Corresponding Address: [email protected] Research Article Abstract: Background: Hydronephrosis is the dilation of the renal to the interruption of flow of urine, it is often due to an pelvis or calyces. Although patients usually presents with some obstructive process. Hydronephrosis is a very common signs and symptoms it can be clinically silent and is diagnosed as condition and it causes significant pain due to obstruction. an incidental finding during evaluation of an unrelated cause. Although calculus is the commonest cause of hydronephosis and Hydronephrosis can result from anatomic or functional hydroureter there are multiple noncalculus aetiology for the same process obstructing the flow of urine which can occur depending on the age and sex of the patient. This study is aimed anywhere from kidneys to the urethral meatus. Symptoms towards meticulous implementation of the accurate diagnostic tools depend on cause, location and duration of the obstruction. for early evaluation of noncalculus hydronephrosis and or Although patients usually presents with some signs and hydroureter and to assess the effectiveness of the early treatment symptoms it can be clinically silent and is diagnosed as towards the renal function sparing. Methods: In this prospective clinical study of 50 patients of hydronephrosis and or hydroureter an incidental finding during evaluation of an unrelated of all age groups and both the genders admitted in the department cause. Although calculus is the commonest cause of of surgery over a period of two years from Dec 2011 to Aug 2013 hydronephosis and hydroureter there are multiple were studied. All the patients were evaluated with detail clinical noncalculus aetiology for the same depending on the age history followed by thorough clinical examination and relevant and sex of the patient e.g. congenital PUJ block and P.U. investigations were done in each case. All the patients with calculus valves being common causes in children, while BEP and were excluded from the study. Results: Incidence of various condition leading to hydronephrosis was PUJ obstruction 38% BPH urethral strictures, carcinoma bladder are commonest 22% Vesicoureteric reflux 16% Neurogenic bladder 2% Stricture causes in males. It is also seen as a physiological response urethra 4% Retroperitoneal mass 6% B.O.O. 2% Gravid uterus 8% to pregnancy in females of child bearing age group while Ureteric stricture 2%. Conclusion: PUJ Obstruction is a most in elderly cancerous infiltration causing obstruction in common cause of noncalculus hydronephrosis. Noncalculus st carcinoma cervix and carcinoma ovary. Experimental hydronephrosis and or hydroureter was most common in 1 decade studies have shown, if an acute obstruction is corrected of life. Incidence noncalculus hydronephrosis and or hydroureter was more common in males than females. In our study unilateral within two weeks, full recovery of renal function is involvement is more common than bilateral. PUJ Obstruction is the possible however, after six weeks function loss is most common cause of unilateral noncalculus hydronephrosis while irreversible which is associated with obstructive BEP is the most common cause of bilateral noncalculus nephropathy and renal scarring. If unrecognized and or hydronephrosis and or hydroureter. Dismembered pyeloplasty is a left untreated hydronephrosis and hydroureter secondary procedure of choice in patients with PUJ Obstruction with good to obstruction, can lead to hypertension, sepsis, infection post-operative recovery in renal function. TURP is the gold standard for the surgical management of BPH. Early surgical and renal failure. Ultrasonography is the first imaging intervention was associated with improved outcome in all the approach in the evaluation of patients with noncalculus patients with noncalculus hydronephrosis and or hydroureter. urinary obstruction. Mild grade hydronephrosis can be Conservative management of hydronephrosis during pregnancy safely managed non operatively with meticulous follow was associated with good outcome. Ultrasound is the most up and surgery can only be considered when signs of important baseline investigation in evaluation of patients with deterioration occurs. Optimal management of patients hydronephrosis. Keywords: Clinical study; Noncalculus; Hydronephrosis; with hydronephrosis and or hydroureter requires Hydroureter integrated therapy involving both medical and surgical Introduction care. The choice of conservative or surgical management Hydronephrosis is defined as a dilatation of the renal of hydronephrosis is based on the results of excretory pelvis and calyces and hydroureter is defined as dilatation urography, fluoroscopy of pelvic and ureteral peristalsis, of ureter. 1 although it is a normal physiological response isotope renography and renal clearance studies but symptoms severity was considered greatly important. International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 10, Issue 3, 2014 Page 438 Kasabe P., R. D. Jaykar, Rahul Wagh Recurrent flank pain still seems to be the best indicator of In this study Ureteropelvic junction obstruction is the the need for surgery, however in noncomplicated benign most common cause of hydronephrosis accounting for hydronephrosis follow up should be directed mainly 38% cases of hydronephrosis .BPH is the second most towards detection of complications. This study is aimed common cause (22%) of hydronephrosis in present towards meticulous implementation of the accurate study.Ureteric stricture is the least common cause of diagnostic tools for early evaluation and to assess the hydronephrosis accounting for 2% of the cases. effectiveness of the early treatment towards the renal function sparing. Table 2: Showing age incidence in hydronephrosis Diagnosis Age in years Material and Methods PUJ <2 2-5 6-10 11-20 21-30 31-40 41-50 51-60 >60 In this prospective study, of 50 patients of hydronephrosis obstruction and or hydroureter of all age groups and both the genders BPH 4 2 1 2 6 1 0 1 2 Vesicoureteric admitted in the department of surgery over a period of 0 0 0 O 0 0 0 4 7 two years from Dec 2011 to Aug 2013 were studied. reflux Neurogenic All the patients were evaluated with detail clinical history 4 1 0 2 0 1 0 0 0 followed by thorough clinical examination and relevant bladder Stricture 0 0 0 0 O 0 1 0 0 investigations were done in each case . urethra Retroperitoneal 0 0 0 0 0 0 0 2 0 mass B.O.O. 1 0 1 0 1 0 0 0 0 Gravid uterus 0 0 0 0 0 0 0 0 1 Ureteric stricture 0 0 0 0 4 0 0 0 0 Total 0 0 0 1 0 0 0 0 0 Photo 1: DTPA Scan Photo 2: IVP showing moderate Percentage 9 3 2 5 11 2 1 7 10 hydronephrosis 18 6 4 10 22 4 2 14 20 Aims and Objectives Most common age group for hydronephrosis and or 1. To study the clinical profile of noncalculus unilateral hydroureter was age group of 20-30 years. In the or bilateral hydronephrosis and or hydroureter present study youngest person affected was 1 day old presenting to our department. and oldest person was 75 yr. Incidence of PUJ 2. To identify the aetiological factors of noncalculus Obstruction was most common in first decade of life hydronephrosis and or hydroureter. accounting 36.84% of cases of PUJ obstruction. In the 3. To evaluate the roles of early definitive management first decade of life most common age group affected in optimizing the renal function . is between children <2 years of age. Second most Criteria of Exclusion common age group for PUJ Obstruction was between 1. Calculus hydronephrosis and or hydroureter. 20-30 years. BPH was the most common cause of 2. Patient with other severe comorbid condition like CCF, hydronephrosis and or hydroureter in adults >60 years Open kochs, advanced jaundice, malignancy and overt of age accounting for 70% cases of hydronephrosis immunocompromised status. and or hydroureter in that age group. In the present Observation and Results study incidence of hydronephrosis and or hydroureter Table 1: Incidence of various condition leading to hydronephrosis was more common in males consist of 68% (34 Diagnosis No of cases Percentage cases).Incidence of PUJ Obstruction was more in males PUJ obstruction 19 38% accounts for 68.42% (13 cases) in males and 31.58% (6 BPH 11 22% Vesicoureteric reflux 8 16% cases) in females. Incidence of VUR is equal in both Neurogenic bladder 1 2% males (50%) and females (50%) with 4 cases each. Stricture urethra 2 4% Vesicoureteric reflux accounts for 11.7% (4 cases) of Retroperitoneal mass 3 6% hydronephrosis and or hydroureter in males and 25% B.O.O. 1 2% (4 cases) of hydronephrosis and hydroureter in Gravid uterus 4 8% females. Incidence of retroperitoneal mass, neurogenic Ureteric stricture 1 2% bladder, ureteric stricture was more in males. Total 50 100% Copyright © 2014, Statperson Publications, International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 10, Issue 3 2014 International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 10, Issue 3, 2014 pp 438-446 Table 3: Sex incidence in hydronephrosis Male Female Diagnosis Total cases No of cases % No of cases % PUJ obstruction 19 13 68.42% 6 31.58% BPH 11 11 100% 0 0% Vesicoureteric reflux 8 4 20% 4 50% Neurogenic bladder 1 1 100% 0 0% Stricture urethra 2 2 100% 0 0% Retroperitoneal mass 3 2 66.67% 1 33.33% B.O.O.
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