What are the next steps for a patient with mild left hydronephrosis and incidentally visualized gallbladder polyps, with the largest measuring 0.9 x 1.1 x 0.8 cm?

From the Guidelines

For a patient with mild left hydronephrosis and gallbladder polyps with the largest measuring 0.9 x 1.1 x 0.8 cm, the next steps should include separate follow-up for both conditions, with a focus on monitoring the hydronephrosis and surveillance of the gallbladder polyps given their small size. The patient should undergo a comprehensive urologic evaluation including urinalysis, renal function tests (BUN, creatinine), and a CT urogram to determine the cause of the obstruction, as hydronephrosis indicates urinary tract obstruction that could be caused by kidney stones, tumors, or strictures 1. For the gallbladder polyps, since the largest polyp is less than 1 cm in all dimensions, no immediate surgical consultation is recommended, but rather surveillance with repeat ultrasound in 6-12 months to monitor for growth, as the risk of malignancy is low for polyps of this size, with studies showing 0% malignancy in polyps smaller than 5 mm 1. The patient should be informed about symptoms of both conditions to monitor - flank pain, hematuria, or decreased urine output for hydronephrosis; and right upper quadrant pain, nausea, or jaundice for gallbladder issues. Key points to consider include:

• The size of the gallbladder polyps is a significant factor in determining the risk of malignancy, with larger polyps having a higher risk 1
• The patient's overall health and medical history should be taken into account when determining the best course of action for both conditions
• Regular follow-up and surveillance are crucial to prevent potential complications and ensure timely intervention if necessary.

From the Research

Next Steps for Mild Left Hydronephrosis and Gallbladder Polyps

The patient's condition involves two distinct issues: mild left hydronephrosis and incidentally visualized gallbladder polyps. The approach to these conditions should be based on current medical understanding and guidelines.

Mild Left Hydronephrosis

• Hydronephrosis is diagnosed more often with the increased availability of computed tomography and ultrasound scanning 2.
• It is an important consideration in patients with abdominal or pelvic pathology as progressive dilation of the upper urinary tract can lead to acute kidney injury and, if not corrected, permanent nephron loss 2.
• The grading scale for hydronephrosis is presented, and treatment options are explained, depending on the severity and cause of the hydronephrosis 3.
• For patients with mild hydronephrosis, the prognosis and management may differ significantly from those with more severe forms, with a potential for a trial of spontaneous passage without immediate intervention 4.

Gallbladder Polyps

• Gallbladder polyps are protuberances of the gallbladder wall projecting into the lumen, usually incidentally found during abdominal sonography, with an estimated prevalence of up to 9.5% of patients 5.
• They can be divided into pseudopolyps and true polyps, with true polyps being either benign or malignant 5.
• Ultrasound is the first-choice imaging method for the diagnosis of gallbladder polyps, enabling the limitation of secondary level investigations and avoidance of unnecessary cholecystectomies 5.
• The management of gallbladder polyps depends on their characteristics, size, and the presence of symptoms or risk factors for malignancy, as outlined in comprehensive reviews of gallbladder disorders 6.

Combined Approach

• Given the patient's mild left hydronephrosis and the presence of gallbladder polyps, a comprehensive approach should include:
  • Monitoring and potential intervention for the hydronephrosis, depending on its cause and progression 2, 3, 4.
  • Further evaluation and management of the gallbladder polyps, considering their size, characteristics, and potential risk for malignancy 5, 6.
• The patient's specific situation and the presence of any symptoms or risk factors should guide the decision-making process for both conditions.