Is there a surgical procedure for moderate hydronephrosis (hydroureteronephrosis)?

From the Guidelines

Surgical intervention, specifically retrograde ureteral stenting or percutaneous nephrostomy (PCN), is usually appropriate for patients with moderate hydroureteronephrosis, as evidenced by the most recent guidelines from the Journal of the American College of Radiology 1. The primary goal of surgical intervention in moderate hydroureteronephrosis is to relieve obstruction, preserve kidney function, and prevent complications.

• Key factors influencing the decision for surgery include:
  • Degree of obstruction
  • Kidney function impairment
  • Presence of infection
  • Patient symptoms
• The choice of surgical procedure depends on the underlying cause of hydroureteronephrosis, with options including:
  • Ureteral stent placement
  • Nephrostomy tube placement
  • Ureteroscopy for stone removal
  • Pyeloplasty for ureteropelvic junction obstruction
  • Ureteroureterostomy for ureteral stricture repair According to the acr appropriateness criteria, for a patient with moderate bilateral hydronephrosis, retrograde ureteral stenting or PCN is usually appropriate 1, highlighting the importance of individualized treatment based on specific patient circumstances and the underlying cause of hydroureteronephrosis.

From the Research

Surgical Procedures for Hydroureteronephrosis

• There are several surgical procedures that can be used to treat hydroureteronephrosis, including:
  • Simple stricture excision and end-to-end anastomosis 2
  • Ureterolysis with omental wrapping 2
  • Ureteroneoimplantation 2
  • Renal autotransplantation 2
  • Ureter-ileum replacement 2
• Minimally invasive procedures such as self-expandable thermostents and pyelovesical bypass prosthesis can also be used 2
• Low transurethral incision of single system intravesical ureteroceles can be an effective treatment for hydroureteronephrosis in children 3

Percutaneous Nephrostomy and Ureteral Stenting

• Percutaneous nephrostomy (PCN) and antegrade ureteral stenting can be used to relieve urinary obstruction and treat hydroureteronephrosis 4
• PCN can be performed under ultrasound and/or fluoroscopic guidance, with a success rate of more than 90% 4
• Ureteral stenting can be performed retrograde or antegrade, with a success rate of more than 90% 4
• PCN may be associated with a higher rate of spontaneous stone passage and better tolerance compared to ureteral stenting 5, 6

Comparison of PCN and Ureteral Stenting

• Studies have compared the outcomes of PCN and ureteral stenting in patients with hydroureteronephrosis, with some showing that PCN is better tolerated and associated with fewer urinary symptoms 5, 6
• A systematic review and meta-analysis found that PCN appears to be the intervention better tolerated, with less impact on the patient's perceived quality of life and less post-operative urinary symptoms, in comparison with ureteral stenting 6