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Hydronephrosis And Vesicoureteral Reflux PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Hydronephrosis and vesicoureteral reflux” by Dr. Farhanul Huda.

This medical PowerPoint presentation is about hydronephrosis and vesicoureteral reflux (VUR), two medical conditions that affect the urinary system.

Hydronephrosis is a condition in which the kidneys become swollen due to a buildup of urine. This occurs when urine cannot properly drain from the kidneys to the bladder. The most common cause of hydronephrosis is a blockage or obstruction in the urinary tract, such as a kidney stone, tumor, or scar tissue. Other causes can include birth defects, enlarged prostate gland, or a urinary tract infection.

Vesicoureteral reflux (VUR) is a condition in which urine flows backward from the bladder to the kidneys. Normally, a valve-like mechanism prevents urine from flowing back up into the kidneys. However, in people with VUR, this mechanism is faulty or absent. VUR is most common in infants and young children, and it can lead to urinary tract infections and kidney damage.

In some cases, hydronephrosis and VUR can be related. For example, VUR can cause urinary tract infections, which can lead to inflammation and scarring in the urinary tract, potentially causing hydronephrosis. Additionally, a blockage in the urinary tract can cause urine to back up into the kidneys, leading to both hydronephrosis and VUR.

Treatment for hydronephrosis and VUR depends on the severity of the condition and the underlying cause. Mild cases may not require any treatment, while more severe cases may require surgery or other medical interventions. Its important to see a doctor if you are experiencing symptoms such as pain, difficulty urinating, or frequent urinary tract infections, as these can be signs of a urinary tract problem.

Tags : Hydronephrosis and vesicoureteral reflux, urinary system, urinary tract, kidney stone, Nephrology, Nephrology PowerPoint presentation

Published on : Jun 07, 2023 | Views : 749 | Downloads : 0

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Slide 1-

HYDRONEPHROSIS & VESICOURETERAL REFLUX Dr. Farhanul Huda Associate Professor Dept. Of Surgery AIIMS Rishikesh
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HYDRONEPHROSIS
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A 32‐year‐old pregnant woman presents to the ER with right sided flank pain. Renal US shows right hydronephrosis. What is the differential diagnosis?
Slide 4-

What is the differential diagnosis? Physiologic hydronephrosis. Dilation of the upper urinary tracts occurs by the 7th week of gestation and may persist for 6 weeks postpartum. Results from both hormonal and mechanical factors. Ureteral dilation is more pronounced on the right side because of dextrorotation of the uterus, whereas the left ureter is more protected from compression by the gas filled sigmoid colon.
Slide 5-

How do you distinguish physiologic hydronephrosis from intrinsic obstruction due to distal ureteral stone disease? Physiological hydronephrosis typically is more on the right side and generally terminates at the pelvic brim. If the hydroureteronephrosis extends below the pelvic brim, distal ureteral obstruction should be considered.
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Imaging suggests physiologic hydronephrosis. How is this managed?
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How is this managed? Analgesia Positioning the patient on her left side. Ureteral stent or nephrostomy tube
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The flank pain resolves with conservative measures and you see the patient in clinic 2 weeks later. Her urinalysis (UA) shows bacteriuria, but she is asymptomatic. Should this be treated?
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Should this be treated? Because of the risk of acute pyelonephritis. The rate of progression of asymptomatic bacteriuria to symptomatic infection is 3‐4 times higher during pregnancy.
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Introduction Common clinical condition. Defined as distention of the renal calyces and pelvis with urine as a result of obstruction of the outflow of urine. Can be physiologic or pathologic, acute or chronic, unilateral or bilateral. Obstructive uropathy ? Functional or anatomic obstruction of urinary flow at any level of the urinary tract. Obstructive nephropathy ? When the obstruction causes functional or anatomic renal damage.
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Pathophysiology
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This decline of GFR can persist for weeks after relief of obstruction. Decreased function of the nephrons. The extent of functional insult is directly related to the duration and extent of the obstruction. Brief obstruction- reversible functional changes. Chronic obstruction - profound tubular atrophy and permanent nephron loss.
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Causes of U/L obstruction Extramural obstruction ■ Tumour from adjacent structures, e.g. carcinoma of the cervix, prostate, rectum, colon or caecum ■ Idiopathic retroperitoneal fibrosis ■ Retrocaval ureter
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Intramural obstruction ■ Congenital stenosis, PUJO ■ Ureterocele and congenital small ureteric orifice ■ Stricture ■ Neoplasm of the ureter or bladder cancer involving the ureteric orifice
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Intraluminal obstruction ■ Calculus in the pelvis or ureter ■ Sloughed papilla in papillary necrosis due to?------
Slide 16-

Causes of B/L Hydronephrosis • congenital: – posterior urethral valves; – urethral atresia; • acquired: – benign prostatic enlargement or carcinoma of the prostate; – postoperative bladder neck scarring; – urethral stricture; – phimosis.
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Clinical features Mild pain or dull aching in the loin. Palpable kidney New onset HTN Recurrent UTIs • Attacks of acute renal colic may occur with no palpable swelling. • Intermittent hydronephrosis (Dietl’s crisis). A swelling in the loin is associated with acute renal pain. Some hours later the pain is relieved and the swelling disappears when a large volume of urine is passed.
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Investigations urine analysis Assesment of renal function USG Colour Doppler USG CT urography MR urography IVP Retrograde pyelography Isotope renography Very occasionally, a Whitaker test is indicated. A percutaneous puncture of the kidney is made through the loin and fluid is infused at a constant rate with monitoring of intrapelvic pressure.
Slide 19-

Treatment Pain management. Renal drainage – stenting/nephrostomy – why? Treat the cause Anderson-Hynes pyeloplasty. Endoscopic pyelolysis
Slide 20-

VESICOURETERAL REFLUX
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INTRODUCTION Characterized by the retrograde flow of urine from the bladder to the kidneys. VUR may be associated with (UTI), HDN and abnormal kidney development (renal dysplasia). Increased risk for pyelonephritis, hypertension, and progressive renal failure. Early diagnosis and vigilant monitoring of VUR are the cornerstones of management.
Slide 22-

CAUSES Primary causes Short or absent intravesical ureter Absence of adequate detrusor backing Lateral displacement of the ureteral orifice Paraureteral (Hutch) diverticulum Secondary causes Cystitis or UTI Bladder outlet obstruction Neurogenic bladder Detrusor instability
Slide 23-

Pathophysiology Ureter inserts into the trigone. The intramural portion of the ureter courses into the bladder wall at an oblique angle. This intramural tunnel length–to–ureteral diameter ratio is 5:1. As the bladder fills with urine and the bladder wall distends and thins, the intramural portion of the ureter also stretches, thins out, and becomes compressed against the detrusor backing. This functions as a flap-valve mechanism and prevents urinary reflux.
Slide 24-

Pathophysiology A short intramural tunnel results in a malfunctioning flap-valve mechanism and VUR. Reflux of infected urine is responsible for the renal damage. bacterial endotoxins leads to release of oxygen free radicals. These oxygen free radicals result in fibrosis and scarring of the affected renal parenchyma.
Slide 25-

Clinical features No specific signs or symptoms unless complicated by UTI. LUTS. Palpable kidney. New onset HTN. Renal failure.
Slide 26-

Workup VUR
Slide 27-

Lab studies Urinalysis and urine culture. RFT. Serum electrolytes
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Imaging studies VCUG/radionuclear cystouretherography USG Nuclear scan Urodynamic studies Cystoscopy
Slide 29-

Treatment
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Medical treatment Surgical treatment Surveillance
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Medical management Administering long-term suppressive antibiotics Correcting the underlying voiding dysfunction (if present) Conducting follow-up radiographic studies (eg, VCUG, nuclear cystography, DMSA scan) at regular intervals
Slide 32-

Surgical treatment Grade III or more reflux. Failure of medical management. Ureteral reimplantation Endoscopic treatment: The principle of the procedure is to inject, under cystoscopic guidance, a biocompatible bulking agent underneath the intravesical portion of the ureter in a submucosal location. The bulking agent elevates the ureteral orifice and distal ureter in such a way that the lumen is narrowed, preventing regurgitation of urine up the ureter but still allowing its antegrade flow.
Slide 33-

A 50 year old female is admitted with abdominal pain and anuria. Radiological studies reveal bilateral impacted ureteric stones with hydronephrosis. Urine analysis showed RBCs with pus cells in urine. Serum creatinine level was 16 mg / dl and blood urea level was 200 mmol/L; which of the following should be the immediate treatment. Lithotripsy Ureteroscopic removal of stones ‘J’ stent drainage Hemodialysis