Urinary system is a continuous pipeline system from kidney to urethral orifice. The discharge of urine depends on the patency of urinary tract and normal urination function. The narrowing or blockage of the pipeline in any part of the urinary tract and the normal function of neuromuscular disorders will eventually lead to hydronephrosis, dilatation, thinning of renal parenchyma and decline of renal function. If there is bilateral obstruction, uremia will have serious consequences.

What causes hydronephrosis?

There are many reasons for urinary flow obstruction, which can be congenital, such as renal ureter junction stenosis, urethral valve, horseshoe kidney and so on. And acquired diseases such as calculus, tumor, prostatic hyperplasia and bladder neck contracture. It may also be caused by extraurethral fibrous band or tumor compression, such as retroperitoneal fibrosis and lymphoma. It may also be a neuromuscular disorder of urethra, such as megaureter. Obstruction can be divided into acute and chronic. Acute obstruction makes the kidney completely lose its function in a short time, but hydronephrosis is not obvious. Chronic obstruction can make hydronephrosis exceed 1000 ml. Once hydronephrosis is complicated with infection, if the obstruction is not removed in time, the infection is difficult to cure, and the infection accelerates the destruction of the kidney, forming a vicious circle and even forming pyonephrosis.

What are the symptoms of hydronephrosis?

1. Primary symptoms, such as stone pain, tumor hematuria, urethral stricture, dysuria, etc.

2. The waist near the stagnant water is very painful.

3. Complications include chills, fever and pyuria.

4. Cystic mass in the affected waist.

5. Chronic renal insufficiency and uremia occurred in bilateral obstruction.

What tests do hydronephrosis need to do?

1. Low back pain and lumbar cystic mass.

2.b-ultrasound: The kidney is enlarged, the cortex is thinned, and there are fluid dark areas of different sizes in the parenchyma.

3.x-ray intravenous urography showed hydronephrosis.

4. Isotopic renogram, obstructive renogram.

5. Retrograde ureteral intubation showed hydronephrosis.

How to treat

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 is caused by stenosis or obstruction of the pipeline in any part of the urinary system and normal neuromuscular function. The symptoms of the disease are low back pain, dysuria, edema of limbs and face. According to the doctor, the condition can be heavy or light, mainly depending on the area of accumulated water. If treated well, it can be recovered quickly, otherwise it will cause life-threatening complications such as uremia or renal failure.

Hydronephrosis refers to urinary tract obstruction, when urine secreted by the kidney is blocked and accumulated in the kidney. After a long time, the renal pelvis expands, which is called hydronephrosis. Severe hydronephrosis will cause the pressure in renal pelvis and calyx to increase, affect glomerular filtration and renal function, and the renal parenchyma will gradually shrink under pressure. There are many reasons for hydronephrosis urinary tract obstruction, such as congenital stricture of ureteropelvic junction, ureteral calculi, bladder tuberculosis, benign prostatic hyperplasia, urethral stricture and so on. Hydronephrosis is easy to cause secondary bacterial infection due to urine stagnation.

Hydronephrosis generally cannot be cured with drugs, but in order to prevent secondary infection and protect renal function, the following measures can be taken before relieving urinary tract obstruction:

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 increasing the burden on the kidney with stagnant water, 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.

Surgery:

According to its etiology, acute and slow onset, infection and degree of renal function damage, combined with the patient's age and cardiopulmonary function.

1. Etiological treatment The most ideal treatment is to remove the etiology of hydronephrosis and keep the affected kidney. If the obstruction does not cause serious irreversible lesions, good results can be obtained after removing the cause. The surgical method depends on the nature of the cause. For example, congenital ureteropelvic junction stenosis can be treated by pyeloplasty, and renal and ureteral calculi can be treated by lithotripsy or lithotomy. These operations can be performed by endoscope in recent years. Hydronephrosis and renal function will be improved after operation.

2. If the nephrostomy is in critical condition or the cause of hydronephrosis cannot be removed, drainage should be performed above the obstruction first, and the operation of removing the cause should be performed after the infection is controlled. When the cause of obstruction cannot be relieved, nephrostomy should be used as a permanent treatment.

3. Nephrectomy When hydronephrosis is serious, the remaining renal parenchyma is too little, or accompanied by serious infection, that is, pyonephrosis, if the contralateral renal function is good, the diseased kidney can be removed.

summary

Urine from the renal pelvis is blocked, resulting in increased pressure in the kidney, expansion of the renal pelvis and calyx, and atrophy of renal parenchyma, which is called hydronephrosis.

(2) Clinical manifestations

Urinary system and its adjacent diseases cause urinary obstruction, which may eventually cause hydronephrosis. Due to the differences in primary causes, locations and degrees of obstruction, the clinical manifestations and progress of hydronephrosis in different patients are not consistent. Congenital diseases, such as ureteropelvic junction stenosis, hydronephrosis caused by the compression of ureter by ectopic blood vessels or fiber bundles under the kidney, develop slowly and have no obvious symptoms for a long time, and abdominal masses do not appear until they reach a certain volume. Secondary hydronephrosis caused by stones, tumors, inflammation, tuberculosis, etc. in various parts of the urinary system, the clinical manifestations are mainly primary symptoms and signs, and the symptoms of hydronephrosis are rarely manifested, which are often found when the obstruction is complete and sudden, such as renal colic caused by renal and ureteral stones. When secondary hydronephrosis is complicated with infection, it is often manifested as the aggravation of primary symptoms.

Hydronephrosis sometimes occurs intermittently, which is called intermittent hydronephrosis. Severe colic, nausea, vomiting and decreased urine volume occurred in the affected abdomen during the attack; After a few hours or more, the pain disappears, and then a lot of urine is discharged. This situation is more common in ureteral obstruction.

Hydronephrosis caused by long-term obstruction will eventually lead to a gradual decline in renal function. When bilateral kidneys or solitary kidneys are completely obstructed, anuria may occur, leading to renal failure.

It should be mentioned that normal pregnancy often has mild hydronephrosis and ureterocele. In addition to the compression of ureter by pregnant uterus, it is caused by the relaxation of renal pelvis and ureter muscles caused by progesterone secretion during pregnancy. This hydronephrosis is a physiological state, and almost all of it occurs on the right side due to anatomical relationship.

(2) Diagnosis

First of all, we must determine the existence of hydronephrosis, and then we must find out the cause, location, degree, infection and renal function damage of hydronephrosis. Attention should be paid to the possibility of hydronephrosis in the differential diagnosis of abdominal masses. The tension of hydronephrosis mass can be different. If the mass tension is low or sometimes hard and sometimes soft, there is a great possibility of hydronephrosis if there is a sense of fluctuation. Some secondary hydronephrosis, its primary symptoms are more obvious, such as tuberculosis, tumors and so on. It is easy to ignore the existence of hydronephrosis. Urinary tract obstruction and hydronephrosis caused by adjacent diseases of urinary system are often not diagnosed in time, and even renal failure or anuria occurs. Laboratory tests should include blood tests for azotemia, acidosis and electrolyte disorder. In terms of urine, besides routine examination and culture, we should also check mycobacterium tuberculosis and exfoliated cells.

Urography is of great value in diagnosis. One of the typical manifestations of excretory urography is the prolonged development time of renal parenchyma. Due to the decrease of glomerular filtration rate, renal tubular urine outflow is slow, water reabsorption is increased, and contrast agent is concentrated in renal cortex, mainly in proximal convoluted tubule, which makes renal arteriography clearer. Therefore, there is a characteristic of acute obstruction caused by kidney shadow thickness. Large dose delayed voiding urography is more helpful for the diagnosis of hydronephrosis. The contrast dose can be increased by 2 ~ 3 times, and the delay time can be as long as 24 ~ 36 hours. When excretory urography is not clear enough, ureteroscopy can be used for catheterization and retrograde pyelography; After inserting the catheter into the renal pelvis, if there is hydronephrosis, a large amount of urine can be extracted, and the renal function of one side can be measured at the same time. If retrograde intubation is difficult, renal puncture radiography can be used instead. During retrograde radiography and puncture radiography, bacteria should be prevented from being brought into the kidney with stagnant water.

Ultrasound, CT and MRI can clearly distinguish whether the swollen kidney is hydronephrosis or solid mass, and can also find the lesions that oppress the urinary system. Because ultrasound has become popular and non-invasive, it can be performed before urography. Radionuclide scanning and renogram can also be used to diagnose hydronephrosis. For cases of dynamic obstruction, urography can be used to observe the peristalsis and emptying of renal pelvis and ureter. Neurogenic bladder can be seen as a "pagoda" with trabecula and false diverticulum.

(3) treatment

According to its etiology, acute and slow onset, infection and degree of renal function damage, combined with the patient's age and cardiopulmonary function.

1. Etiological treatment The most ideal treatment is to remove the etiology of hydronephrosis and keep the affected kidney. If the obstruction does not cause serious irreversible lesions, good results can be obtained after removing the cause. The surgical method depends on the nature of the cause. For example, congenital ureteropelvic junction stenosis can be treated by pyeloplasty, and renal and ureteral calculi can be treated by lithotripsy or lithotomy. These operations can be performed by endoscope in recent years. Hydronephrosis and renal function will be improved after operation.

2. If the nephrostomy is in critical condition or the cause of hydronephrosis cannot be removed, drainage should be performed above the obstruction first, and the operation of removing the cause should be performed after the infection is controlled. When the cause of obstruction cannot be relieved, nephrostomy should be used as a permanent treatment.

3. Nephrectomy When hydronephrosis is serious, the remaining renal parenchyma is too little, or accompanied by serious infection, that is, pyonephrosis, if the contralateral renal function is good, the diseased kidney can be removed.

(d) postoperative care of patients with hydronephrosis

1Pc urine leakage

Related factors: related to surgery.

Nursing measures: (1) use metronidazole 10ml as drainage tube for washing renal pelvis twice a day;

(2)TDP irradiated the wound for 30 minutes, once a day/kloc-0;

(3) Record the urine volume of left kidney and the volume of wound drainage tube;

(4) Inform the doctor to change the dressing in time after it is soaked.

(5) Keep the drainage unobstructed, and properly fix the drainage tube to prevent compression, folding and distortion.

2 infection

Related factors: related to surgical trauma and indwelling catheter

Nursing measures: (1) Use antibiotics according to the doctor's advice;

(2) measure the body temperature four times a day;

(3) Wash the urethral orifice twice a day with 0. 1% bromogeramine, and change the drainage bag every day;

(4) Keep the drainage unobstructed, and strictly carry out various aseptic operations;

(5) After anal exhaust, encourage patients to drink more water, more than 3000ml per day, and eat.

A nutritious diet.

3 pain

Related factors: related to surgical trauma.

Nursing measures: (1) Comfort patients to relax their nervousness;

(2) Instruct patients and their families to use the analgesic pump correctly, protect the painful parts and master the relief.

A painful method;

(3) Give analgesics according to the doctor's advice, and observe and record the effect after medication;

(4) Adjust the comfortable posture.

Risk of skin damage

Related factors: related to postoperative bed rest.

Nursing measures: (1) explain the importance of keeping skin intact to patients and their families, and obtain their cooperation, and

Explain to them the methods of skin self-care and the risk factors of skin injury;

(2) Assisting patients to change their postures regularly and orderly, and massaging each bony process;

(3) Clothes, trousers and mattresses should be kept soft, flat, dry, clean and free of residue;

(4) Instruct patients in bed activity skills and make bed activity plans.

5 constipation

Related factors: related to bed rest.

Nursing measures: (1) Encourage patients to strengthen bedridden activities;

(2) Eat more foods with high fiber content such as vegetables and fruits, and drink more water;

(3) Patients can be given physical defecation when defecation is difficult;

(4) Instruct patients to develop good defecation habits.