Overview
Acquired hydronephrosis results from obstruction or dysfunction affecting the urinary tract, leading to dilation of the renal pelvis and calyces. It can arise from various etiologies including post-obstructive changes, vesicoureteral reflux, or iatrogenic causes 1.Diagnosis
Prenatal detection via ultrasonography, particularly noting dilation of the upper urinary tract 1.
Postnatal imaging studies such as ultrasound, CT urography, or MRI to confirm diagnosis and assess extent 1.
Voiding cystourethrogram (VCUG) to evaluate for vesicoureteral reflux 1.Management
Observation: For mild cases or transient obstruction, monitoring may be appropriate 1.
Surgical Intervention: Including ureteral reimplantation, valve ablation (e.g., posterior urethral valves), or stent placement for persistent obstruction 1.
Endourological Procedures: Utilization of advanced instrumentation like guide-eye systems to enhance safety and efficacy during procedures 3.Special Populations
Pregnancy: Fetal hydronephrosis requires careful prenatal management; options include observation, vesicoamniotic shunting, amnioinfusion, and direct valve interventions, each with significant risks 1.
Pediatrics: Early diagnosis and intervention are crucial, often involving surgical correction of obstructions like posterior urethral valves 1.Key Recommendations
Prenatal findings of upper tract dilation should prompt thorough evaluation to differentiate between obstructive and non-obstructive causes (Evidence: Moderate 1).
Fetal interventions for LUTO should be considered cautiously, weighing risks and potential benefits carefully (Evidence: Expert opinion 1).
Advanced endourological techniques, such as those incorporating guide-eye systems, can improve procedural outcomes in managing acquired hydronephrosis (Evidence: Weak 3).References
1 Kurtz MP. Prenatal Diagnoses and Intervention. The Urologic clinics of North America 2023. link
2 Kerfoot BP, Masser BA, Dewolf WC. The continued decline of formal urological education of medical students in the United States: does it matter?. The Journal of urology 2006. link00314-4)
3 Giesy JD, Hoskins MW, Hermann GD, Fogarty TJ. The guide-eye ureteral access system. The Urologic clinics of North America 1990. link