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Hydronephrosis describes hydrostatic dilation of the renal pelvis and calyces as a result of obstruction to urine flow downstream. Alternatively, hydroureter describes the dilation of the ureter , and hydronephroureter describes the dilation of the entire upper urinary tract (both the renal pelvicalyceal system and the ureter).
The size of the renal pelvis plays a major role in the grading of hydronephrosis. Normally, the anteroposterior diameter of the renal pelvis is less than 4 mm in fetuses up to 32 weeks of gestational age and 7 mm afterwards. [2] In adults, 13% of the normal population have a transverse pelvic diameter of over 10 mm. [3]
Hydronephrosis is seen as an anechoic fluid-filled interconnected space with enhancement within the renal sinus, and normally, the dilated pelvis can be differentiated from the dilated calyces. [1] Figure 13. Hydronephrosis due to ureteropelvic junction obstruction in a pediatric patient. [1] Several conditions can result in urinary obstruction.
An intravenous pyelogram is used to look for problems relating to the urinary tract. [5] These may include blockages or narrowing, such as due to kidney stones, cancer (such as renal cell carcinoma or transitional cell carcinoma), enlarged prostate glands, and anatomical variations, [5] such as a medullary sponge kidney. [6]
Bladder outlet obstruction can be identified during routine prenatal ultrasonography as dilation of the fetal urinary tract [3] and decreased amniotic fluid levels. If dilation of the fetal urinary tract is suspected during pregnancy, an ultrasound of the infant's kidneys and bladder should be obtained after birth.
Obstructive uropathy (obstruction of urine flow from one or both kidneys) can lead to hydronephrosis with dilatation of the renal pelvis. [190] Kidney stones can also be formed in the kidneys (nephrolithiasis). [191] The cause of acute kidney injury in most cases is ischemic or toxic injury.
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Urethral dilatation and catheter placement. This can be performed in the Emergency Department, a practitioner's office or an operating room. The advantage of this approach is that the urethra may remain patent for a period of time after the dilation, though long-term success rates are low.