eMedicine Specialties > Urology > Hydronephrosis and Ureter Disorders

Hydronephrosis and Hydroureter: Follow-up

Author: Srinivas Vourganti, MD, Staff Physician, Department of Urology, Case Western Reserve University, University Hospitals of Cleveland
Coauthor(s): Prakash Maniam, MD, Staff Physician, Department of Urology, St Mary's Hospital of Troy
Contributor Information and Disclosures

Updated: Feb 25, 2008

Follow-up

Further Inpatient Care

  • Monitor patients for postobstructive diuresis. This is a marked polyuria observed after relief of an obstructed system.
    • Patients who are most likely to experience postobstructive diuresis present with chronic obstruction, edema, congestive heart failure, hypertension, weight gain, and azotemia. Clinically significant postobstructive diuresis is usually seen only in the setting of prior bilateral obstruction or, similarly, a unilateral obstruction of a solitary functioning kidney.
      • This postobstructive diureses can lead to a marked diuresis with the wasting of sodium, potassium, phosphate, and the divalent cations. Management involves avoiding severe volume depletion, hypokalemia, hyponatremia, hypernatremia, and hypomagnesemia.
      • Volume or free-water replacement is appropriate only when the salt and water losses result in volume depletion or a disturbance of osmolality. In many cases, excessive volume or fluid replacement prolongs the diuresis and natriuresis. An appropriate starting fluid for replacement is 0.45% saline. During this period, vital signs, volume status, urine output, and serum and urine chemistry and osmolality should be monitored.
      • Postobstructive diuresis is usually self-limited. It usually lasts for several days to a week but may, in rare cases, persist for months.

Further Outpatient Care

  • Once the diagnosis is made and treatment is performed, follow-up imaging studies are necessary to assess for resolution of the hydronephrosis and hydroureter.
  • Additionally, perform laboratory studies on renal function to assess the recovery of renal function.

Complications

  • Postobstructive diuresis refers to polyuria that occurs after relief of obstruction. Patients with edema, congestive heart failure, hypertension, weight gain, and azotemia are most likely to exhibit this condition. It is more common in patients with chronic obstruction. Postobstructive diuresis is usually clinically significant only in patients whose obstruction involves both kidneys or a unilateral obstruction of a solitary functioning kidney.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Once the diagnosis of hydroureteronephrosis is made, immediately refer the patient to a urologist. Delay in referral could result in irreversible loss of renal function.
  • If bladder outlet obstruction is the cause of the hydroureteronephrosis and a large volume is drained, the catheter should be left in place, with a leg bag. Severe bladder distention can be associated with impaired detrusor function for the first few days after relief of obstruction. The catheter allows drainage during this recovery period.
  • Before performing any invasive procedure to relieve an obstructed system, assess the degree of function in the contralateral kidney.

Special Concerns

  • Hydronephrosis and hydroureter during pregnancy are physiologic and are most pronounced during the third trimester. This is believed to be due to mechanical obstruction by the gravid uterus and the effects of increased progesterone levels.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Martin I Resnick, MD †, to the development and writing of this article.



More on Hydronephrosis and Hydroureter

Overview: Hydronephrosis and Hydroureter
Differential Diagnoses & Workup: Hydronephrosis and Hydroureter
Treatment & Medication: Hydronephrosis and Hydroureter
Follow-up: Hydronephrosis and Hydroureter
References
[ CLOSE WINDOW ]

References

  1. Chuang FR, Lee CH, Chen CS, Weng HH, Wang IK. Bilateral moderate hydroureteronephrosis due to uterine prolapse: two case reports and review of the literature. Ren Fail. Sep 2003;25(5):879-84. [Medline].

  2. Smith SJ, Bosniak MA, Megibow AJ, Hulnick DH, Smiles S. CT demonstration of rapid improvement of retroperitoneal fibrosis in response to steroid therapy. Urol Radiol. 1986;8(2):104-7. [Medline].

  3. Chen MY, Zagoria RJ, Dyer RB. Radiologic findings in acute urinary tract obstruction. J Emerg Med. May-Jun 1997;15(3):339-43. [Medline].

  4. El-Ghoneimi A. Laparoscopic management of hydronephrosis in children. World J Urol. Dec 2004;22(6):415-7. [Medline].

  5. Fielding JR, Fox LA, Heller H, Seltzer SE, Tempany CM, Silverman SG, et al. Spiral CT in the evaluation of flank pain: overall accuracy and feature analysis. J Comput Assist Tomogr. Jul-Aug 1997;21(4):635-8. [Medline].

  6. Hsu TH, Streem SB, Nakada SY. Management of Upper Urinary Tract Obstruction. In: Kavoussi LR, Novick AC, Partin AW, Peters CA, Wein AJ, eds. Campbell-Walsh Urology. Vol 2. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:1195-1226.

  7. Pain VM, Strandhoy JW, Assimis, DG. Pathophysiology of urinary tract obstruction. In: Kavoussi LR, Novick AC, Partin AW, Peters CA, Wein AJ, eds. Campbell-Walsh Urology. Vol 2. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:1227-73.

  8. Shokeir AA, El-Diasty T, Eassa W, Mosbah A, Mohsen T, Mansour O, et al. Diagnosis of noncalcareous hydronephrosis: role of magnetic resonance urography and noncontrast computed tomography. Urology. Feb 2004;63(2):225-9. [Medline].

  9. Singh V, Patel R, Pradhan P. Single umbilical artery and associated hydronephrosis: a report of 2 cases. J Reprod Med. Feb 2004;49(2):136-8. [Medline].

  10. Smith RC, Verga M, McCarthy S, Rosenfield AT. Diagnosis of acute flank pain: value of unenhanced helical CT. AJR Am J Roentgenol. Jan 1996;166(1):97-101. [Medline].

  11. Spencer JA, Chahal R, Kelly A, Taylor K, Eardley I, Lloyd SN. Evaluation of painful hydronephrosis in pregnancy: magnetic resonance urographic patterns in physiological dilatation versus calculous obstruction. J Urol. Jan 2004;171(1):256-60. [Medline].

  12. Stoller ML, Gentle DL, McDonald MW, Reese JH, Tacker JR, Carroll PR, et al. Endoscopic management of upper tract urothelial tumors. Tech Urol. 1997;3(3):152-7. [Medline].

  13. Watson G. Problems with double-J stents and nephrostomy tubes. J Endourol. Dec 1997;11(6):413-7. [Medline].

  14. Ziedel ML, Pirtskhalaishvili G. Urinary tract obstruction. In: Brenner BM, ed. Brenner and Rector's The Kidney. 7th ed. Philadelphia, Pa: Elsevier Inc; 2004:1867-94.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

hydronephrosis, hydroureter, urinary tract obstruction, renal pelvis dilation, calyces dilation, hydroureteronephrosis, hydronephrotic system, pyonephrosis, urine flow interruption, interrupted urine flow, pyelolymphatic backflow, renal colic, advanced pelvic malignancy, prostatic hypertrophy, prostate cancer, cervical cancer, pregnancy, ureter calculi, ureteral calculi, ureteropelvic junction obstruction, UPJ obstruction, urine reflux, postobstructive diuresis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Srinivas Vourganti, MD, Staff Physician, Department of Urology, Case Western Reserve University, University Hospitals of Cleveland
Disclosure: Nothing to disclose.

Coauthor(s)

Prakash Maniam, MD, Staff Physician, Department of Urology, St Mary's Hospital of Troy
Prakash Maniam, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Richard A Santucci, MD, FACS, Chief of Urology, Detroit Receiving Hospital; Specialist-in-Chief of Urology, Detroit Medical Center; Chief of Urologic Trauma Surgery, Sinai Grace Hospital; Director, The Center for Urologic Reconstruction
Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, and Société Internationale d'Urologie (International Society of Urology)
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf, Jr, MD, FACS, David A Bloom Professor of Urology, Director, Division of Minimally Invasive Urology, Department of Urology, University of Michigan Medical Center
J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Stephen W Leslie, MD, FACS, Founder and Medical Director of the Lorain Kidney Stone Research Center, Clinical Assistant Professor, Department of Urology, Medical College of Ohio
Stephen W Leslie, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, National Kidney Foundation, and Ohio State Medical Association
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.