Hydronephrosis treatment tends to focus on clearing any present infections or blockages, draining excess urine from the kidney, determining and possibly correcting the source of what is causing the condition to exist and managing pain.
Immediate Hydronephrosis Treatment
Once hydronephrosis is detected through laboratory tests and imaging studies, immediate treatment must be provided to the patient to prevent or minimize damage to the kidney. Treatment usually consists of:
- Removing the excess urine from the kidney: This is typically done through a procedure known as a nephrostomy. During a nephrostomy, the doctor will insert a catheter directly into the kidney through an incision in the skin. The catheter will then allow urine to be removed directly from the kidney, reducing pressure on the organ and preventing permanent damage.
- Treating infections: When bacteria enters the urinary tract and is not quickly removed by the body, urinary tract infections (UTIs) can happen. Hydronephrosis often causes these infections because the kidney is unable to expel the microbes rapidly due to the excess storage of urine. After a diagnosis of hydronephrosis is made, the doctor will perform urine and blood tests to see if an infection is present. Antibiotics—prescribed for up to seven days—are usually administered.
- Identifying the underlying condition causing hydronephrosis: Once pressure from the kidney has been relieved and underlying infections have been treated, the doctor may need to run additional tests in order to identify what is causing hydronephrosis to occur. Urine and blood tests, imaging studies to view the structures of the urinary system (e.g., ultrasound, x-rays, MRI) or urodynamic exams (uroflowmetry or cystometric analysis) can all indicate the source. Urodynamic tests, in particular, measure bladder function and look at capacity, pressure, urine flow speed and the coordination of the muscles that control the bladder.
Hydronephorosis Underling Causes
After excess urine has been drained from the kidney and infections have been addressed, treating the underlying cause of hydronephrosis is then necessary to prevent damage to the organ and keep the condition from recurring. Understanding where the source lies will lead the physician to choose the proper treatment.
- Kidney stones: If kidney stones (hard, crystallized masses) are blocking the flow of urine from the kidney to the bladder, no treatment may be needed. Kidney stones may pass on their own. However, if the kidney stone does not pass, a procedure known as lithotripsy may be recommended. In this procedure, high energy sound waves are used to break up the stone and open the ureter so that they can flush out through the urine.
- Overactive bladder: When an overactive bladder (the strong and unexpected urge to urinate because of bladder contractions) results in the development of hydronephrosis, it can be treated with medications such as anticholinergic drugs. Trospium (Sanctura), solifenacin (Vesicare), darifenacin (Enablex) and oxybutynin (Oxytrol, Ditrpoan) are examples of anticholinergic medications that work to relax bladder muscles. These medications are well tolerated and have few side effects such as dry mouth, constipation, dizziness, sleepiness and changes in vision.
- Enlarged prostate (men): An enlarged prostate may also block the flow of urine from the kidneys. The prostate is the reproductive gland in males. It surrounds the urethra (the tube that connects the bladder to the genitals so that urine can pass out of the body) and generates the fluid needed to transport sperm during ejaculation. Prostate enlargement, also known as benign prostatic hyperplasia or BPH, occurs when the gland enlarges. As it continues to grow, more and more pressure is placed on the urethra, often leading to urination and bladder problems. BPH can be treated with medications that work to reduce the size of the prostate or through surgery to remove all or part of the gland.
- Pregnancy: During pregnancy, the uterus increases in size as the fetus grows. This can compress the ureters (tubes that connect the kidney to the bladder), resulting in a blockage of urine flow to the bladder. Although a nephrostomy may be needed to drain the excess urine from the kidney, additional treatment is not recommended, as the condition typically resolves following childbirth.
- Congenital abnormalities: Some children are born with structural abnormalities at the junction between the ureter and renal pelvis (ureteropelvic junction). If this is the underlying cause of hydronephrosis, a surgical procedure known as pyeloplasty will be required. During this procedure, the surgeon removes the structural blockage in the ureter and reconnects the kidney to the ureter so that urine can flow to the bladder.
- Tumors: Cancerous tumors of the cervix, uterus, prostate or bladder can lead to obstructions—and thus hyrdonephrosis—since the organs are either part of or near the urinary system. Treating the tumors with chemotherapy, radiation and/or surgery may be needed to alleviate symptoms of the condition.
- Kidney cancer: Cancerous tumors of the kidney (the bean-shaped organ that filters blood and removes wastes that are then funneled to the bladder) may also cause hydronephrosis and need to be treated with chemotherapy, radiation and surgery. The latter procedure, known as a nephrectomy, requires the surgeon to make an incision in the abdomen, cut the ureter and surrounding blood vessels and remove either part or all of the kidney. However, this alternative is only recommended if other treatment options have not been successful.
Hydronephrosis Outcomes
Prognosis for the patient with hydronephrosis will depend on the cause of the condition, the damage caused to the kidney and the outcomes of treating the underlying condition. In most cases, hydronephrosis cannot be prevented. If hydronephrosis symptoms develop, prompt treatment will reduce the risk of damage to the kidney, leading to a better prognosis.
References
Hydronephrosis. (2012). Merck Manual. Retrieved from http://www.merckmanuals.com/home/kidney_and_urinary_tract_disorders/obstruction_of_the_urinary_tract/hydronephrosis.html.
Hydronephrosis—Adult. (2012). NYU Langone Medical Center. Retrieved from http://medicine.med.nyu.edu/conditions-we-treat/conditions/hydronephrosis%E2%80%94adult#treatment.
LaRusso, L. (2012, October 1). Hydronephrosis—Adult. Conditions & Procedures, 1-3.
Lithotripsy. (2013). US National Library of Medicine. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/007113.htm.
