Hydronephrosis can be divided into primary and secondary. Primary hydronephrosis is also called congenital hydronephrosis, spontaneous hydronephrosis and idiopathic hydronephrosis. The main reason is the obstruction of ureteropelvic junction, which is often due to the fact that the muscle cells in this area are separated by a large number of collagen fibers and lose their normal arrangement, which can not effectively transmit the electrical activity from pacing cells and block the transmission of normal peristalsis.

Congenital hydronephrosis is mostly caused by mechanical obstruction. The main reasons are: ① ectopic blood vessels, such as vagal blood vessels from the lower pole of the kidney; ② Fibrous cord; ③ High attachment of renal pelvis and ureter; ④ Obstruction of ureteropelvic junction and valve; ⑤ Local tortuosity of ureter caused by membrane adhesion. Congenital hydronephrosis can also be caused by dynamic reasons, such as segmental non-dynamic sexual dysfunction.

Secondary hydronephrosis is mostly caused by other diseases of urinary system. Primary diseases can generally be found by routine examination, while some diseases need special examination (such as CT and magnetic resonance imaging). ) to make a clear diagnosis. These diseases mainly include: ① upper urinary tract obstructive diseases, tumors, polyps, stones, tuberculosis, inflammation, injury, deformity, diverticulum, nephroptosis and so on. ② Upper urinary tract compression during pregnancy and menstrual period, abdominal, pelvic or retroperitoneal masses, idiopathic retroperitoneal fibrosis, ectopic blood vessels and ovarian vein compression with congestion; ③ Lower urinary tract obstructive diseases, benign prostatic hyperplasia, prostate cancer, urethral stricture, vesicoureteral reflux, etc.

1. Conservative therapy

(1) Hydronephrosis is mild, and the disease progresses slowly. It remains to be seen that the renal function has reached a balanced and stable state, but the progress of hydronephrosis should be checked regularly.

(2) Obstruction that can be relieved by itself, such as physiological hydronephrosis in pregnant women.

2. Surgical therapy

(1) surgical indications: hydronephrosis is getting worse gradually, with obvious clinical symptoms, decreased renal function, clear causes of obstruction, and complications, requiring surgical treatment.

(2) the principle of surgical treatment:

① Clear the obstructive diseases that cause hydronephrosis, such as taking stones; Relieve the compression of fibrous cord or vagus nerve blood vessels; Prostatic hyperplasia can be excised or excised.

② Severe hydronephrosis leads to complete loss of renal function or severe infection with empyema, but the contralateral renal function is good and nephrectomy is feasible.

③ The renal function of the affected side is very poor due to hydronephrosis, and the function of the contralateral kidney is poor due to other diseases, even uremia. Hydronephrosis should be performed first, and obstruction should be further treated after renal function is restored.

④ Bilateral hydronephrosis, pay attention to exclude the cause of lower urinary tract obstruction. Generally, treat the good side first, and then treat the serious side after the situation improves. Usually a unilateral nephrostomy is done first.

⑤ Hydronephrosis and funnel obstruction are mostly caused by stones. If there are no clinical symptoms, surgery is generally not needed.

⑥ The principle of plastic surgery, pay attention to the normal anatomical relationship between kidney and ureter, keep the drainage of kidney and ureter unobstructed, and the anastomosis should be at the lowest part of renal pelvis. Prevent varus when anastomosing, and try to be funnel-shaped after suture. When repairing, the adhesion scar of fibrous tissue should be removed as much as possible to avoid hurting blood supply, and the surrounding adipose tissue should be properly reserved to cover the operation field.