Hydronephrosis is mild, progress of the disease is slow, the renal function has reached equilibrium and stable state, but it should be checked regularly to understand the progress of hydronephrosis. A self lifting obstruction, such as a physiological hydronephrosis in a pregnant woman.
Operation indication: hydronephrosis is progressive, clinical symptom is obvious, renal function is declining, obstruction is clear, complication is existed, surgical treatment should be performed.
Principles of surgical treatment:
Remove the obstructive diseases caused by hydronephrosis: if stones should be removed, relieve the compression of the fibrous band or the vagus vessels, and the benign prostatic hyperplasia can be cut or removed by electrical resection.
Severe hydronephrosis caused by ipsilateral renal function loss or serious infection empyema, but the contralateral renal function is good, feasible with nephrectomy.
Hydronephrosis caused by poor side kidney function, the contralateral kidney due to other diseases, poor functioning, and even uremia, hydronephrosis should be prior to nephrostomy, to restore the function of the kidney, and further treatment of obstruction.
Bilateral hydronephrosis, pay attention to exclude the cause of lower urinary tract obstruction. Generally treat the good side first, after the situation has improved, and then deal with the serious side. Unilateral nephrostomy is usually performed first.
The hydronephrosis of the small kidney is caused by the obstruction of the funnel. If there is no clinical symptom, there is no need for surgery.
The principle of plastic surgery is to pay attention to the normal anatomy of the kidney and ureter, and to keep the drainage of the ureter open. The anastomosis should be at the lowest point of the renal pelvis. Prevent varus when anastomosis, and strive to funnel after suture. As far as possible, the fibrous tissue adhesions, scar removal, clean, do not hurt blood supply, appropriate preservation of surrounding adipose tissue, to cover the surgical field.
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