From the Guidelines
The treatment for hydroureteronephrosis should prioritize relieving urinary obstruction to prevent kidney damage, with the choice of intervention depending on the underlying cause, severity, and presence of symptoms or complications, as evidenced by recent guidelines 1.
Overview of Hydroureteronephrosis Treatment
The management of hydroureteronephrosis is multifaceted, involving:
- Conservative monitoring for mild cases without infection or significant obstruction, using regular ultrasounds and kidney function tests 1.
- Antibiotics for cases with infection, based on urine culture results.
- Drainage procedures such as ureteral stent or nephrostomy tube placement for obstructive causes.
- Definitive treatment addressing the underlying cause, which could include lithotripsy, surgical removal of stones, tumor resection, stricture management, or correction of congenital abnormalities.
Importance of Prompt Intervention
Prompt treatment is crucial to prevent permanent renal damage, as obstructive hydronephrosis can lead to increased hydrostatic pressure and subsequent nephron atrophy 1. The urgency of intervention increases with factors such as bilateral obstruction, infection, acute kidney injury, or severe symptoms.
Diagnostic Approaches
Imaging studies like CT urography (CTU) and scintigraphic diuresis renography (DRG) play significant roles in diagnosing and differentiating nonobstructive hydronephrosis from hydronephrosis due to true functional obstruction 1. CTU is particularly useful for visualizing both the upper and lower urinary tracts, while DRG involves the administration of a diuretic and a radiotracer to demonstrate flow and obstruction.
Recent Guidelines and Recommendations
Recent guidelines from the American College of Radiology 1 emphasize the importance of appropriate radiologic management of urinary tract obstruction, including the use of percutaneous antegrade ureteral stenting and safety nephrostomy in certain cases. These procedures are considered equivalent alternatives for managing complex obstructions, especially in patients with advanced disease or significant renal impairment.
Conclusion on Best Approach
Given the potential for significant morbidity and mortality associated with untreated hydroureteronephrosis, a prompt and tailored approach to diagnosis and treatment is essential, prioritizing the relief of obstruction and addressing the underlying cause, as supported by the most recent and highest quality evidence 1.
From the Research
Treatment for Hydroureteronephrosis
The treatment for hydroureteronephrosis typically involves relieving the obstruction that is causing the condition. This can be achieved through various methods, including:
- Percutaneous nephrostomy: a procedure where a tube is inserted through the skin into the kidney to drain the urine [ 2 , 3 ]
- Ureteral stent: a small tube that is inserted into the ureter to allow urine to flow around the obstruction [ 2 , 3 ]
- Surgery: may be necessary to remove the obstruction or repair any damage to the ureter or kidney [ 4 , 5 ]
Comparison of Treatment Options
Studies have compared the effectiveness of percutaneous nephrostomy and ureteral stent in treating hydroureteronephrosis. The results suggest that:
- Percutaneous nephrostomy may be superior to ureteral stent in terms of relieving symptoms and improving quality of life [ 2 , 3 ]
- Ureteral stent may be associated with more urinary symptoms, such as hematuria and dysuria [ 3 ]
Special Considerations
In some cases, hydroureteronephrosis may be caused by a rare condition, such as inguinal herniation of the transplant ureter [ 4 ]. In these cases, surgical repair may be necessary to restore normal urine flow. Additionally, asymptomatic bilateral delayed ureteral obstruction can occur after endoscopic treatment for vesicoureteral reflux [ 5 ].