(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.

(3) Postoperative problems and treatment: Generally speaking, hydronephrosis caused by urinary tract obstruction is a long-term pathological process. Surgical removal of obstruction only solves the problem morphologically and creates conditions for the recovery of renal function. There will be a series of problems in the recovery of renal function after the obstruction is relieved, which must be paid great attention by urologists. Otherwise, improper handling of these problems will also have serious consequences. Such issues included questions on the following:

① diuresis after obstruction: after acute upper urinary tract obstruction is relieved 1 ~ 3 days, the patient may have diuresis. The urine output in 24 hours can reach 3000~8000ml. Continuous discharge of a large amount of urine in a short period of time will inevitably lead to imbalance of water, electrolyte and acid-base balance, and even threaten the life of patients in serious cases. There are two main reasons for polyuria after obstruction: a. The accumulation of urea nitrogen and sodium excretion hormone in blood after obstruction reduces the reabsorption function of renal tubules for water, sodium and chlorine; B. The renal tubular epithelium flattened, the absorption area decreased, and the alkaline phosphatase and Na-K-ATPase decreased obviously. With the progress of the disease course, renal tubular function gradually recovered, and urine volume gradually returned to normal.

② Inverse balance problem: According to the inverse balance problem in the process of renal function recovery, the recovery of renal function depends on the stimulation of metabolic load in the body. Therefore, when one side of hydronephrosis is seriously damaged, if the renal function of the opposite side is completely normal, even if the renal obstruction is relieved, it cannot be stimulated by metabolites in the body, so the recovery of renal function will be very slow. However, if there is some damage to the contralateral kidney, the function of the affected kidney will recover quickly after the obstruction is relieved. Therefore, if both kidneys are obstructed, the obstruction of one kidney with relatively good renal function can be relieved first, and then the obstruction of the other kidney can be relieved as soon as the patient's general situation allows.

③ Influence of obstruction on kidney: After obstruction, the whole body blood volume increases due to water and sodium retention; Increased renin activity can lead to hypertension. After the obstruction is relieved or the affected kidney is removed, the blood pressure of some patients can decrease accordingly. When hydronephrosis occurs, the erythropoietin produced by the kidney increases, which can lead to erythrocytosis and will return to normal after nephrectomy.

(2) Prognosis

There are many reasons for hydronephrosis, which should be treated according to different reasons. Most patients need surgery. It is the key to treat hydronephrosis to gain time to remove obstruction and restore renal function. Timely treatment is satisfactory. Acute complete obstruction should be operated in time, and the nephron will be damaged after 24 hours. Renal function decreased by 30% after obstruction 10; After 30 ~ 40 days of obstruction, renal function damage is difficult to recover. The sooner chronic obstruction is relieved, the better. After a period of time, renal function can be improved, especially in children. Nephrectomy with unilateral hydronephrosis has normal contralateral renal function and does not affect health.

(1) The goal of treatment is to remove obstruction, improve renal function, relieve symptoms, eliminate infection and repair its normal anatomical structure on the basis of eliminating the etiology.

(II) Estimation of treatment ① Age: Infants should be treated as soon as possible, and young adults can be properly observed. If there is progress, we must operate in time. For people over 50 to 60 years old, surgery should be considered as soon as possible to maintain good renal function. ② Estimation of renal function and obstruction: A. Normal renal tissue can maintain the minimum function of life at least 1/5. If it is not necessary, try not to drain the kidney to prevent infection. B for asymptomatic hydronephrosis patients without infection, B-ultrasound, CT and intravenous pyelography can be performed every 6 ~ 12 months. If there is no progress, you can suspend the operation. Obstruction at the junction of renal pelvis and ureter can cause stones. Therefore, when taking stones, it is necessary to explore whether there are reasons for the formation of stones. If there is stenosis, it should be corrected at the same time. ③ Evaluation of intrarenal and extrarenal pyeloplasty: Intrarenal pyeloplasty is difficult to treat. ④ Timing of bilateral hydronephrosis operation: When bilateral hydronephrosis is not infected, the side with poor function can be treated first, so that the opposite side will continue to be in compensatory hypertrophy state of functional load. The kidney on the plastic side recovered well under certain stimulation. For patients with infection, severe lateral surgery should be selected first, and the contralateral surgery should be performed as soon as possible. If only one side with good function is infected, in order to maximize the preservation of renal function and control infection, surgery should be given priority, and surgery should be considered after the condition of the other side is stable.

One side of the kidney with good function has hydronephrosis, but plastic surgery can be done to save renal function, and surgery should be considered first. If the contralateral kidney has been damaged and has no function, it is necessary to wait until the renal function of the surgical side is restored and the condition is stable before deciding whether to perform amputation immediately.

(3) Treatment:

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. Local treatment: For the lesions at the obstruction site, local treatment can be used, such as adhesion separation, fiber band cutting, vascular transposition anastomosis, stone removal, etc. When the local compression time is too long and the local development of ureter is seriously damaged, this section of ureter should be removed and anastomosed again.

3. When the obstruction has caused severe hydronephrosis, you must first make a fistula and drain.

4. 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.

(3) Plastic surgery: The key points that must be mastered in plastic surgery: ① Make the ureteropelvic anastomosis at the lowest point of the renal pelvis. ② The ureteropelvic anastomosis should be funnel-shaped. ③ When repairing, the surrounding fibers, adhesions and scar tissues should be removed, but the blood supply should not be damaged. ④ Resection of redundant renal pelvis wall to maintain a certain renal pelvis tension. If the hydronephrosis is too large, the thin renal cortex can be inverted, folded and fixed to reduce the renal internal volume. ⑤ To reduce the leakage of urine at the anastomotic site, double pigtail catheters can be placed. In order to avoid scar fibrosis caused by urine leakage and hemolysis stagnation around the anastomosis, a negative pressure suction tube can be placed outside the anastomosis to fully drain. ⑥ There are many plastic surgery methods, but at present, considering the etiology and pathology, it is considered that it is better to remove the diseased segment and then anastomose it.

(4) Postoperative problems and treatment: Generally speaking, hydronephrosis caused by urinary tract obstruction is a long-term pathological process. Surgical removal of obstruction only solves the problem morphologically and creates conditions for the recovery of renal function. There will be a series of problems in the recovery of renal function after the obstruction is relieved, which must be paid great attention by urologists. Otherwise, improper handling of these problems will also have serious consequences. Such issues included questions on the following:

① diuresis after obstruction: after acute upper urinary tract obstruction is relieved 1 ~ 3 days, the patient may have diuresis. The urine output in 24 hours can reach 3000~8000ml. Continuous discharge of a large amount of urine in a short period of time will inevitably lead to imbalance of water, electrolyte and acid-base balance, and even threaten the life of patients in serious cases. There are two main reasons for polyuria after obstruction: a. The accumulation of urea nitrogen and sodium excretion hormone in blood after obstruction reduces the reabsorption function of renal tubules for water, sodium and chlorine; B. The renal tubular epithelium flattened, the absorption area decreased, and the alkaline phosphatase and Na-K-ATPase decreased obviously. With the progress of the disease course, renal tubular function gradually recovered, and urine volume gradually returned to normal.

② Inverse balance problem: According to the inverse balance problem in the process of renal function recovery, the recovery of renal function depends on the stimulation of metabolic load in the body. Therefore, when one side of hydronephrosis is seriously damaged, if the renal function of the opposite side is completely normal, even if the renal obstruction is relieved, it cannot be stimulated by metabolites in the body, so the recovery of renal function will be very slow. However, if there is some damage to the contralateral kidney, the function of the affected kidney will recover quickly after the obstruction is relieved. Therefore, if both kidneys are obstructed, the obstruction of one kidney with relatively good renal function can be relieved first, and then the obstruction of the other kidney can be relieved as soon as the patient's general situation allows.

③ Influence of obstruction on kidney: After obstruction, the whole body blood volume increases due to water and sodium retention; Increased renin activity can lead to hypertension. After the obstruction is relieved or the affected kidney is removed, the blood pressure of some patients can decrease accordingly. When hydronephrosis occurs, the erythropoietin produced by the kidney increases, which can lead to erythrocytosis and will return to normal after nephrectomy.

After suffering from hydronephrosis, we should not only actively cooperate with the doctor's treatment, but also pay attention to diet. The following are some recipes suitable for patients with hydronephrosis (for reference only, please consult your doctor for details):

1. Coix seed porridge

Material: coix seed 30g, rice 100g. Add some water and cook it into porridge, one meal a day. Strengthening spleen, promoting diuresis and reducing swelling.

Function: Used for patients with nephrotic edema, manifested as spleen deficiency, hydronephrosis, anorexia and soft stool.

2. Scallion-white perilla porridge

Materials: onion 3 ~ 5, perilla leaf 10g, japonica rice 00g. Boil glutinous rice porridge first, then add scallion and perilla leaves, cover tightly and stew for a while. It should be eaten while it is hot, one day 1 meal. Warming yang and promoting diuresis to reduce swelling.

Function: Used for patients with edema and hydronephrosis caused by deficiency of spleen and kidney yang.

3. Fresh stewed winter melon

Ingredients: 200g wax gourd (including green husk), sugar 1 teaspoon. Cut the washed wax gourd into pieces, add sugar and a little water to the pot, and simmer slowly.

Function: diuresis and detumescence, clearing away heat and toxic materials. It is used for patients with nephritis edema, fever and hydronephrosis.

4. Broussonetia papyrifera porridge

Materials: 50g of Broussonetia papyrifera leaves are chopped, added with water 1000mL, and boiled for 0.500 ml. Remove residue and add appropriate amount of rice to cook porridge. As a diet, eat regularly and don't stop.

Function: Treating patients with chronic nephritis, intractable edema and hydronephrosis.

5. Old hen soup

Materials: old hen 1 hen (eviscerated), astragalus, dried tangerine peel 15g, Amomum villosum 6g, ginger bark 15g, raw hawthorn 30g, eating meat and drinking soup.

Function: Treating chronic nephritis edema and hydronephrosis.