Is Severe Hydronephrosis Serious?

Hydronephrosis involves the collection of urine in the kidney due to incomplete emptying of the urinary tract. This results in swelling and obstruction of the kidney. The swelling or obstruction can occur at:

• Opening of the kidneys
• The ureters
• The bladder
• The urethra

Hydronephrosis may be of two types:

• Unilateral hydronephrosis (only one kidney is affected)
• Bilateral hydronephrosis (both the kidneys are affected)

Hydronephrosis, if left untreated, can lead to kidney failure.

The different stages of severe hydronephrosis include:

• Grade 0: There Is hardly any swelling.
• Grade 1: Mild swelling at the center of the kidney (pelvis) but no dilation in the chambers of the kidney (calyces).
• Grade 2: Mild swelling of the pelvis and the calyces.
• Grade 3: Moderate swelling of the pelvis and calyces.
• Grade 4: Severe swelling of pelvis and calyces, which appear ballooned.

The most common cause of hydronephrosis includes:

• Kidney stones
• Tumors in the bladder or prostate gland
• Benign prostatic hyperplasia (enlargement of the prostate gland causing pressure in the urethra)
• Blood clots in the kidney or ureter
• Narrowing of the urinary tract
• Nerve or muscle problems in the kidney or ureters
• Urinary retention
• Vesicoureteral reflux (a condition where urine flows backward from the bladder to the kidney)
• Ureterocele (a condition where the lower part of the ureter may protrude into the bladder)
• Ureteropelvic junction obstruction (blockage at the point where the kidney joins the ureter)
• Ureterovesical junction obstruction (blockage at the point where the ureter joins the bladder)
• Posterior urethral valves (a congenital condition in which there are abnormal laps of tissue in the urethra)
• Urethral cancer

In women, hydronephrosis may occur as a result of:

• Pregnancy (expansion of uterus can exert pressure on the ureters)
• Uterine prolapse (uterus sags down from its normal position)
• Cystocele (a condition where the wall between a woman’s bladder and her vagina weakens and allows the bladder to droop into the vagina)

Hydronephrosis generally doesn’t cause any symptoms. If symptoms occur, they include:

• Nausea
• Vomiting
• Blood in the urine
• Weakness or malaise
• Fever due to a urinary tract infection
• Chest pain
• Shortness of breath
• Leg swelling
• Sudden or intense pain in the back or side
• No key changes in urine output
• Cloudy urine
• Painful urination

In the case of electrolyte abnormalities, it may lead to:

• Heart rhythm disturbance
• Muscle spasms

Surgery would be recommended only in the most severe cases. The goal of the surgery is to reduce swelling and pressure in the kidney by establishing a free flow of the urine. The most common surgical procedure used for the treatment of hydronephrosis is pyeloplasty. Pyeloplasty repairs the most common type of blockage, ureteropelvic junction (blockage at the point where the kidney joins the ureter). It removes the narrowed or obstructed part of the ureter and reconnects the healthy portion to the kidney’s drainage system. The physician may perform pyeloplasty in:

• Traditional or open incision method
• Robot-assisted pyeloplasty