Hydronephrosis: Diagnosis & treatment Options in Turkey 2024

Hydronephrosis: What is it?

Hydronephrosis is a condition characterized by dilatation of the kidney due to an accumulation of stagnant urine. This dilation is caused by a blockage, often related to a kidney stone, tumor, or congenital malformation, that prevents urine from flowing freely to the bladder.

Left untreated, hydronephrosis can lead to severe pain, recurrent urinary tract infections and progressive deterioration of kidney function, culminating in chronic kidney failure.

Treatment, tailored to the underlying cause, aims to remove the obstruction, either medically or surgically, to restore normal urinary flow and maintain kidney health.

Causes of hydronephrosis

Hydronephrosis is an enlargement of the kidney caused by an obstruction in the urinary tract. This obstruction can have several causes:

• Congenital malformations: present at birth, they can narrow the urinary tract.
• Kidney stones: These small crystals block the passage of urine.
• Tumors: Abnormal growths can compress the urinary tract.
• Pregnancy: A growing uterus can pinch the ureters.
• Infections: Certain infections can cause edema and block the urinary tract.

Consequences of renal dilatation

Renal dilatation increases the pressure inside the kidney, causing :

• Pain: often in the flank, similar to renal colic.
• Urinary tract infections: stagnant urine is a breeding ground for bacteria.
• Loss of kidney function: If the obstruction persists, the kidney may be irreversibly damaged.

Back pain or kidney colic? Don't delay: see a doctor! A urologist or nephrologist will be able to make an accurate diagnosis thanks to a kidney ultrasound. These pains can be a sign of hydronephrosis, which can damage your kidneys if not treated quickly.

Diagnosis of hydronephrosis

Ultrasound is the gold standard in the diagnosis of hydronephrosis. This imaging test measures the degree of dilation of the urinary tract and looks for anatomical abnormalities at the origin of the disorder. Many cases are detected by prenatal ultrasound.

Ultrasound not only confirms the diagnosis but also identifies the underlying cause, such as pyeloureteral junction syndrome, which is common in children.

In some cases, additional tests such as cystography and renal scintigraphy may be needed to refine the diagnosis and assess renal function.

Early diagnosis of hydronephrosis is essential to prevent serious complications. Indeed, prolonged urinary obstruction can lead to irreversible loss of renal function due to scarring of the renal tissue.

In addition, the accumulation of urine promotes the development of recurrent urinary tract infections and the formation of kidney stones. In the long term, untreated hydronephrosis can also contribute to the development of hypertension.

Progression of hydronephrosis

The progression of hydronephrosis depends largely on the underlying cause of the urinary obstruction.

If the obstruction is due to a stone, it can often be removed or fragmented, allowing full recovery of renal function.

If the obstruction is due to a tumor, the prognosis depends on the extent of the tumor. Early diagnosis is essential to preserve kidney function and provide appropriate treatment.

Hydronephrosis treatment in Turkey

Hydronephrosis requires individualized treatment to remove the obstruction to urine flow, relieve pressure on the kidney, and prevent complications.

The choice of treatment in Turkey depends on several factors:

• Cause of obstruction: stones, tumors, malformations, etc.
• Severity: degree of renal dilatation, impairment of renal function, etc.
• Associated symptoms: urinary tract infections, pain, etc.
• General condition of the patient: age, other diseases, etc.

The different therapeutic approaches for hydronephrosis include :

• Medical treatment: antibiotics (for infections),analgesics (for pain),alpha-blockers (to facilitate drainage).
• Endovascular treatments: ureteral stenting or nephrostomy to maintain or create a urinary outflow tract.
• Surgery:
  • Percutaneous nephrolithotomy, ureterolithotripsy: to remove stones.
  • Pyeloplasty: to correct anatomical abnormalities.
  • Partial or total nephrectomy: in the most severe cases, to remove part or all of the kidney.

The goal of treatment is to restore normal urine flow, preserve kidney function and improve the patient's quality of life.

Follow-up after treatment

After treatment, regular follow-up is necessary to monitor kidney function and detect any recurrence. Complementary examinations (e.g. ultrasound, renal scintigraphy) allow us to assess the effectiveness of the treatment and adjust the follow-up accordingly.

The duration of hydronephrosis treatment, hospitalization, recovery and possible complications vary considerably depending on :

• The cause of the hydronephrosis.
• The severity of the obstruction: the greater the obstruction and the more damage to the kidney, the more complex the treatment.
• The age and general health of the patient.

Length of treatment and hospitalization

Antibiotics and anti-inflammatories can usually be given on an outpatient basis without the need for hospitalization.

Procedures such as stenting or nephrostomy are often performed under local anesthesia and may be done on an outpatient basis or require a short hospital stay.

The length of your hospital stay will vary depending on the procedure and your overall health. Your healthcare team will tell you exactly how long you can expect to stay in the hospital.

Recovery and convalescence

The postoperative period following hydronephrosis surgery is generally characterized by pain, nausea, and difficulty urinating.

Recovery time varies depending on the complexity of the surgery, but physiotherapy sessions can speed up the return to normal activity. In most cases, patients return to a satisfactory quality of life within a few weeks of surgery.

Treatment of hydronephrosis is not without risk. In addition to urinary tract infections and bleeding, recurrent obstruction can lead to progressive loss of kidney function or even end-stage renal disease.