Question 2: How to treat adult hydronephrosis? Surgery should be done early. Reasonable application of plastic surgery technology to correct the abnormality of ureteropelvic junction and strive for a greater degree of renal function recovery. Nephrectomy is feasible if the hydronephrosis is serious and the renal function is seriously damaged and the contralateral kidney is normal.
The principle of operation is that simple orthopedic surgery should be performed when the obstruction is light and the renal pelvis and calyx are seriously dilated; If the dilatation is obvious, the narrow segment of the lesion and the excessively dilated renal pelvis should be removed, and then anastomosis should be performed; In more serious cases, nephrectomy is performed. The success rate of operation varies from report to report, depending on the degree of dilatation of renal pelvis and calyx, the functional state of kidney, and whether the operation method is reasonable, generally between 80% and 90%.
The treatment of hydronephrosis should be more cautious, and the kidney should be preserved as much as possible. Generally, there are several situations: ① One side has serious water accumulation and the other side is light: the serious side can be treated first. In this way, there is no concern about renal insufficiency during the operation, and the safety of contralateral operation can be increased after the operation is successful. The indication of operation should be carefully judged on the lighter side, and its development can be closely observed if necessary. ② Serious hydrops on both sides: it can be treated by stages, but it is better to treat the heavier side first. ③ The hydronephrosis on both sides is light, so careful analysis should be made to determine the indication of operation.
If renal drainage is needed before the obstruction is relieved (such as severe infection or renal failure due to bilateral diseases), renal puncture can be performed and a renal drainage tube can be placed. At present, percutaneous drainage tube can replace nephrostomy open surgery.
When the ureter needs long-term drainage due to serious peripheral lesions (such as cervical cancer and colon cancer), double J-shaped catheters (or double pigtail catheters) can be placed through percutaneous puncture. Catheter is made of silica gel, inserted into ureter through renal pelvis, and blocked into bladder through ureter. After taking out the tube core, the section that enters the bladder cavity bends into a ring by itself, and the proximal end also bends into a ring in the renal pelvis. In this way, urine from the renal pelvis can enter the bladder through the catheter and be discharged by itself, thus eliminating the inconvenience of carrying a nephrostomy tube and a urine reservoir. Catheter plays the role of internal drainage, which is a more suitable method for advanced cancer or other dying patients.
Question 3: What about hydronephrosis? First of all, I suggest you go to a regular big hospital for treatment. Here are some knowledge about hydronephrosis for prenatal examination, but I hope you can go to the hospital as soon as possible. Don't delay the illness. Now medical insurance is treating you, and most medical expenses can be reimbursed. Hope to adopt, thank you! ! The following is a little knowledge for your reference.
1. Eliminate the cause and relieve the obstruction. 2. If the situation is too bad or the cause is complicated, percutaneous nephrostomy can be used to drain the kidney first. 3. Severe hydronephrosis or pyonephrosis, if the contralateral renal function is good, nephrectomy is performed. 4. If surgical resection is impossible, double "T" tubes or stent tubes should be placed. 5. The main purpose of medication is to prevent and control infection before and after operation. Use drugs that have no or little damage to renal function as far as possible. Hydronephrosis can not be cured with drugs, but in order to prevent secondary infection and protect renal function, before the treatment of relieving urinary tract obstruction, we can use: ① antibacterial drugs, such as erythromycin and cephalosporin. ② Traditional Chinese medicine treatment: Bupleurum, Cortex Phellodendri, Scutellariae Radix, Semen Plantaginis and other antibacterial Chinese medicines. Can be used for clearing away heat and toxic materials. Dietary health care ① Increase energy intake, but in order to avoid water accumulation and increase the burden on the kidneys, it is not advisable to eat too much food rich in protein. Energy intake mainly depends on carbohydrates and fatty foods. (2) If unilateral hydronephrosis occurs, don't limit the amount of drinking water; if bilateral hydronephrosis occurs, the amount of drinking water per day should be limited.
Question 4: What about hydronephrosis? Hello, glad to help you. Hydronephrosis is the enlargement of renal pelvis and calyx caused by urinary tract obstruction, accompanied by atrophy of renal tissue. Hydronephrosis is very harmful to people, and uremia can occur in severe cases. Let's look at hydronephrosis.
Once hydronephrosis occurs, the following tests are usually performed:
1. After enlargement of renal calices, routine urine examination often shows red blood cells and protein.
2. Renal function examination includes urea nitrogen, creatinine determination and clearance test. When the renal function of bilateral hydronephrosis is seriously damaged, serum creatinine and urea nitrogen increase.
3. Image inspection
(1)X-ray urography: enlarged renal shadow and stones can be shown.
(2)B-ultrasound: This method is simple, convenient and non-invasive, and it is accurate to detect hydronephrosis and renal cortex thickness. It can be preliminarily differentiated from renal cyst and renal tumor.
(3) Color Doppler ultrasound: By measuring the renal arteriovenous blood flow spectrum, the hemodynamic changes of the affected kidney can be reflected.
(4)IVU urography: One or both hydronephrosis, obstructive position and obstructive degree (partial or complete) can be known. When hydronephrosis seriously affects the renal function of the affected side, dysplasia can occur.
(5) Retrograde pyelography: Inserting the ureteral catheter into the obstruction and injecting the contrast agent quickly can show the location and nature of the obstruction. If hydronephrosis is serious, the ureteral catheter can be retained and the urine can be drained after retrograde radiography to relieve the renal function of the affected side and make further treatment.
(6) Nepheline imaging: It is suitable for patients who are dissatisfied with IVU imaging and fail to perform retrograde pyelography. It can be seen that the renal pelvis is oval with smooth edges. The kidney cup with mild hydronephrosis is full and rod-shaped, while the kidney cup with severe hydronephrosis is round and swollen like a cotton peach, and the renal parenchyma becomes thinner.
(7)CT: It can clearly show the size, outline, essence, hydronephrosis and other lesions outside the urinary tract. Enhanced CT can be used to understand the differentiation between renal function and renal lesions.
(8)MRI: MRI urography can be performed for patients with renal insufficiency, contrast agent allergy, obstructive lesions to avoid interventional infection and intolerance to IVU. Using urine as T2-weighted strong signal can scan the urinary system in coronal, sagittal and transverse directions, which is of great value for the diagnosis of the location and nature of obstruction.
(9) Renal pelvis perfusion test: It is a valuable examination method in recent years to diagnose cases of urinary tract obstruction that are difficult to determine.
4. The renogram is an obstructive renogram curve. If diuretic renogram is used, it is helpful to judge whether there is clear obstruction and whether surgery is needed. Methods After routine renogram examination, the patients were instructed to drink water, and furosemide (0.5mg/kg) was injected intravenously before renogram. The following results may appear: both results are normal curves, indicating that there is no obstruction; The obstruction of routine renogram and normal diuretic renogram suggests that there is still compensatory emptying after upper urinary tract obstruction, or that upper urinary tract dilatation may be caused by hypotonia of smooth muscle of renal pelvis and ureter. The routine renogram is normal, and the diuretic renogram is an obstruction curve, indicating that there is potential obstruction; Both times were obstructive renograms, which were true obstruction.
The above is what to do with hydronephrosis. I hope my answer can help you. The harm of hydronephrosis is very great, so we must pay attention to it and develop good living habits in daily life, which plays an important role in the prevention of hydronephrosis.
Question 5: How to treat severe hydronephrosis is a secondary lesion caused by urinary tract obstruction and one of the most common secondary symptoms of urinary calculi. Depending on the location of the obstruction, edema can be local or involve the whole kidney. For example, renal calices stones only cause obstruction and hydronephrosis in the renal calices where the stones are located. Hydronephrosis caused by kidney calculi can be local or the whole kidney. Hydronephrosis caused by ureteropelvic junction stones and ureteral stone obstruction will spread to the whole kidney, while lower urinary tract obstruction can cause bilateral hydronephrosis. The damage of hydronephrosis to the kidney is the pressure increase caused by obstruction, which can make the kidney tissue degenerate, shrink, function decline and eventually lose its function. Secondary hydronephrosis is an important indication for surgical treatment of urinary calculi. Once hydronephrosis is found, it should be treated in time without delay. According to the degree of hydronephrosis, hydronephrosis is clinically divided into mild hydronephrosis, moderate hydronephrosis, severe hydronephrosis and huge hydronephrosis. The classification of hydronephrosis is often not mainly based on the size of renal pelvis, but on the morphological changes of renal calices caused by obstruction. * * * part of renal calices is flattened, with slight hydrops; Renal calices become spherical with moderate hydronephrosis; Severe dilatation of renal pelvis and calyx is severe hydronephrosis; Giant hydronephrosis refers to the loss of renal structure in the kidney, and the amount of hydronephrosis is greater than 1000 ml or more than 24 hours of urine (children). Some hydronephrosis can return to normal form after obstruction is relieved, such as mild and moderate hydronephrosis; Some hydronephrosis can't return to normal form after the obstruction is relieved, or even don't recover at all. Generally, those with short obstruction time, light accumulated water and young age have more chances to recover, while those with long obstruction time and heavy accumulated water are not easy to recover. Just because hydronephrosis no longer occurs after the obstruction is relieved does not mean that the obstruction has not been relieved. When the shape of renal pelvis and calyx changes to a certain extent, it becomes irreversible. At this time, as long as hydronephrosis is no longer aggravated, renal function can still be protected and maintained. Patients with hydronephrosis after the obstruction is relieved must be reviewed regularly. Only after several reexaminations can the changes be alleviated can the obstruction cease to exist. If necessary, make a diuretic renogram to judge whether there is obstruction.