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. 2017 Sep;43(3):337-344.
doi: 10.5152/tud.2017.78379. Epub 2017 Aug 1.

Giant hydronephrosis: still a reality!

Kawaljit Singh Kaura  1 , Manoj Kumar  1 , Ashok Kr Sokhal  1 , Ashok Kr Gupta  1 , Bimalesh Purkait  1 , Durgesh Saini  1 , Satyanarayan Sankhwar  1
Affiliations

Giant hydronephrosis: still a reality!

Kawaljit Singh Kaura et al. Turk J Urol. 2017 Sep.

Abstract

Objective: Giant hydronephrosis (GH) is a rare entity in both developed and developing countries with less than 500 cases reported in the literature. Delayed diagnosis and management of GH, can result in long-term complications like hypertension, rupture of the kidney, renal failure and malignant change. We aim to highlight the importance of this often neglected entity and build a consensus for its early diagnosis and management.

Material and methods: Patients with GH were thoroughly worked up, managed and followed up between June 2013 and December 2015 and epidemiologic, radiological, perioperative and follow-up data was recorded.

Results: A total of 35 patients (adults and children) were reported. Flank pain in adults and abdominal lump in children were the most common clinical presentation. Percutaneous nephrostomy tube was placed in all patients and detailed work up was done to reach final diagnosis. Pelvi-ureteric junction obstruction (PUJO) was the final diagnosis in 32 patients (91.4%). Kidneys were non-functioning in 13 cases (37.1%) so nephrectomies were performed. Reduction pyeloplasty with nephropexy was done in 21 patients (60%) with 81% success and 23.1% complication rates.

Conclusion: GH requires early diagnosis and management to prevent higher nephrectomy rate along with poor success rate of conservative surgery like pyeloplasty.

Keywords: Giant hydronephrosis; nephrectomy; pelvi-ureteric junction obstruction; pyeloplasty.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1. a–d
Figure 1. a–d
Young child presenting with distended abdomen and lump with difficult breathing (a). Immediate after percutaneous nephrostomy (PCN) tube placement, distension was relieved and patient improved symptomatically (b). Ultrasonography showing hugely dilated sac of the right kidney (c). Renal scan showing non- functioning right kidney (d)
Figure 2. a,b
Figure 2. a,b
Ultrasonography of an adult male presenting with abdominal distension and pain, shows hugely dilated sac of the right kidney with internal echoes, suggestive of pyonephrosis (a). Contrast-enhanced computed tomography scan showing giant hydronephrosis of the right kidney (b).
Figure 3. a–c
Figure 3. a–c
Nephrostogram of a patient with giant hydronephrosis showing hugely dilated pelcicalyceal system of the left kidney (a). Intraoperative view during pyeloplasty showing a large redundant sac of the kidney for which reduction pyeloplasty with nephropexy was done (b, c)
See this image and copyright information in PMC

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