Lower Urinary Tract Obstruction Resulting in Bilateral Hydronephroureterosis
Number:28ESURABS0047
Type:Educational Electronic Presentation
Authors: Deuk Jae Sung, Sung-Hye You
Keywords:Urinary Tract Obstruction, Hydronephrosis, Hydronephroureterosis
SECTIONS
Educational objective

Bilateral hydronephroureterosis, which leads to impairment in renal function, may develop with or without mechanical obstruction of urinary tract. So, it is important to find out the level and causes of urinary tract obstruction with imaging studies for appropriate diagnosis and treatment. This review is conducted to remind a practical concept and to define the management algorithm in urgent setting for bilateral hydronephroureterosis with lower urinary tract obstruction.

Topic Review

Etiology and Pathophysiology

 

The causes of urinary tract obstruction vary with the age of patients. Benign prostate hypertrophy (BPH), prostate cancer, bladder cancer, retroperitoneal or pelvic neoplasms, and stones are the primary causes in older and young patients. On the other side, congenital anatomic causes (including stricture at the ureterovesical or ureteropelvic junction, posterior urethral valves, or vesicoureteral reflux) account for most cases in neonates and children.                                                   

Following the onset of urinary tract obstruction, pressure in pelvicalyceal system increases proximal to the obstruction due to continued generation of urine and glomerular filtration, which leads to...

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Fig. 1. Cystocele and bilateral hydronephroureterosis in an 86-year-old woman. . Coronal reconstruction CT images show protruding perineal mass (arrows) containing the bladder (A), and bilateral lower ureters (arrows) are stretched below the symphysis pubis (B) and proximally dilated (arrowheads).
Fig. 2 Bilateral hydronephroureterosis in a 78-year-old man with benign prostate hyperplasia. US images show moderate hydronephrosis in both kidneys (A, B), and diffuse wall thickening (arrows) of urinary bladder due to bladder outlet obstruction by benign prostate hyperplasia (C).
Conclusions

Large number of bilateral hydronephroureterosis be brought about by of lower urinary tract obstruction. The decision to perform PCN should not be made easily based on US finding of bilateral hydronephrosis. The level and causes of urinary tract obstruction should be determined with CT before management, and little-invasive procedure can prevent renal impairment in many patients with bilateral hydronephroureterosis.