From the Guidelines
Treatment for hydronephrosis should focus on promptly addressing the underlying cause of urinary obstruction to prevent kidney damage, with the primary approach involving relieving the blockage through surgical intervention or conservative management depending on the severity and cause of the obstruction. The most recent and highest quality study, 1, emphasizes the importance of prompt treatment to prevent permanent renal damage.
Causes and Classification of Hydronephrosis
Hydronephrosis can be classified by cause and by unilateral versus bilateral involvement, with obstructive hydronephrosis further classified by level of obstruction, complete versus partial obstruction, and intrinsic versus extrinsic obstruction 1. Causes of hydronephrosis include urolithiasis, malignant obstruction, stricture, upper urinary tract infection, traumatic or ischemic injury, postradiation changes, retroperitoneal fibrosis, supravesical or bladder dysfunction, bladder outlet obstruction, mechanical compression, endometriosis, schistosomiasis, drug effects, vessel-related and/or congenital ureteropelvic junction obstruction, and congenital posterior urethral valves 1.
Diagnostic Approaches
Diagnostic approaches for hydronephrosis may include CT urography (CTU), which is tailored to improve visualization of both the upper and lower urinary tracts, and scintigraphic diuresis renography (DRG) to differentiate nonobstructive hydronephrosis from hydronephrosis due to true functional obstruction 1.
Treatment Approaches
Treatment approaches for hydronephrosis depend on the severity of obstruction, presence of infection, underlying cause, and the patient's overall health status. For mild cases without complete obstruction, conservative management with close monitoring, hydration, and antibiotics (if infection is present) may be appropriate, while more severe cases may require surgical intervention such as ureteral stent placement, nephrostomy tube insertion, or correction of anatomical abnormalities 1. Common antibiotic choices for associated infections include ciprofloxacin 500mg twice daily or trimethoprim-sulfamethoxazole 160/800mg twice daily for 7-14 days, and pain management typically involves NSAIDs like ibuprofen 400-600mg every 6 hours or narcotic analgesics for severe pain.
Follow-Up and Monitoring
Follow-up imaging with ultrasound or CT scans is essential to monitor resolution of the condition, as prompt treatment is crucial to prevent permanent kidney damage 1. The specific treatment approach should be guided by the most recent and highest quality evidence, with consideration of individual patient factors and the potential risks and benefits of different treatment strategies.
From the Research
Treatment Options for Hydronephrosis
- Percutaneous nephrostomy and ureteral stents are two common methods for diverting hydronephrosis caused by stones 2
- The choice of treatment depends on various factors, including symptoms, patient age, and sex 2
- Percutaneous nephrostomy has been shown to be superior to ureteral stents in terms of procedure success rate, relief of symptoms, and quality of life 2
Diagnosis and Grading of Hydronephrosis
- Hydronephrosis can be diagnosed using various imaging modalities, including computed tomography, ultrasound, and magnetic resonance imaging 3, 4, 5
- The severity of hydronephrosis can be graded based on the degree of dilation of the renal collecting system 4, 5
- Grading of hydronephrosis can help guide management and predict outcomes in patients with ureteral colic 4
Management of Hydronephrosis
- The management of hydronephrosis depends on the underlying cause and severity of the condition 3, 5
- Treatment options may include percutaneous nephrostomy, ureteral stenting, or other interventions to relieve obstruction and prevent further kidney damage 2, 6, 5
- The choice of treatment should be individualized based on patient factors and preferences 6