Publication:

Unilateral hydronephrosis in adults: etiology, clinical presentations and management

Background Hydronephrosis is dilatation of renal pelvis and calyces resulting from intermittent and incomplete obstruction to the urine outflow with incidence of 1:100. This study aims to evaluate etiological factors, clinical presentations, diagnostic modalities and management options of unilateral hydronephrosis.

Methods In a tertiary care based observational study, patients more than 18 years age of either gender with unilateral loin pain with or without lump in loin were clinically diagnosed as unilateral hydronephrosis and confirmed on imaging studies were enrolled as subjects. Pregnant patients and patients not consenting were excluded. Patients with mild unilateral hydronephrosis were managed conservatively. Those of moderate to severe grade were investigated with CT urography and those with no excretion of dye in affected kidney were further investigated with DTPA scan. In patients with function of less than 10% on DTPA scan were subjected for nephrectomy.

Results Of the total 72 patients of unilateral hydronephrosis enrolled, 50 (69.44%) were due to ureteric calculi, 18 (25%) were PUJ obstruction and 4 (5.56%) were renal calculi. Highest incidence was seen in third and fourth decade with Males to female ratio of 1.25:1. Commonest symptom was pain in abdomen followed by hematuria. Ureteric calculi of size less than 7 mm were given conservative trial and rests were managed surgically. Out of total 72 patients 43 patients were managed conservatively and rest 29 were treated surgically.

Conclusions Ureteric calculus, pelviureteric junction obstruction and renal calculus were the etiological factors causing unilateral hydronephrosis and management was as per etiology.