Clinical manifestations of hydronephrosis: 1. Primary symptoms, such as pain caused by stones, hematuria caused by tumors, dysuria caused by urethral stricture, 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.
Auxiliary inspection: 1. Low back pain and cystic mass in the waist. 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.
Treatment principle of hydronephrosis: 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.
The way of treatment:
1. local treatment: local treatment can be used to solve the pathological changes in the obstruction site, such as adhesion separation, fibrous 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.
2. When the obstruction has caused severe hydronephrosis, you must first make a fistula and drain.
3. Plastic surgery: The key points that plastic surgery must master: ① Make pyeloplasty 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.