Giant hydronephrosis: still a reality!

Abstract

Objective: Giant hydronephrosis (GH) is a rare entity in both developed and developing countries with less than 500 cases reported in the literature. Delayed diagnosis and management of GH, can result in long-term complications like hypertension, rupture of the kidney, renal failure and malignant change. We aim to highlight the importance of this often neglected entity and build a consensus for its early diagnosis and management. Material and methods:Patients with GH were thoroughly worked up, managed and followed up between June 2013 and December 2015 and epidemiologic, radiological, perioperative and follow-up data was recorded.Results: A total of 35 patients (adults and children) were reported. Flank pain in adults and abdominal lump in children were the most common clinical presentation. Percutaneous nephrostomy tube was placed in all patients and detailed work up was done to reach final diagnosis. Pelvi-ureteric junction obstruction (PUJO) was the final diagnosis in 32 patients (91.4%). Kidneys were non-functioning in 13 cases (37.1%) so nephrectomies were performed. Reduction pyeloplasty with nephropexy was done in 21 patients (60%) with 81% success and 23.1% complication rates. Conclusion:GH requires early diagnosis and management to prevent higher nephrectomy rate along with poor success rate of conservative surgery like pyeloplasty.

Experience of a tertiary-level urology center in the clinical urological events of rare and very rare incidence. IV. Urological surprises: 2. Clinically visible giant hydronephrosis in adults: Is there a significant function?

“…This principle issue may evolve on the management of giant hydronephrosis in relatively young patients and bilateral cases [23]. However, the initial placement of a temporary nephrostomy tube, before deciding elective nephrectomy or correction of the primary cause, is still controversial [1,6,7]. In the current study, however, although imaging tools evaluated the kidneys as non-functioning, the initial placement of nephrostomy tube improved the kidney function significantly in 5 patients.…”

“…Here, however, we adhered to this term to express the state of massive renal dilatation. Hydronephrosis is commonly reported from the developing countries where its common causes such as urolithiasis and bilharziasis are endemic [1,6,8,10]. Congenital pelvi-ureteral junction obstruction has been reported as the commonest cause of giant hydronephrosis with more occurrences among pediatrics [2,7,13].…”

“…Compensation of the contralateral kidney is a part of the natural history of severe unilateral hydronephrosis [17]. Abdominal distention is the common presenting symptom of giant hydronephrosis [1,5]. It seldom fills the whole abdomen to be confused with tense ascites [7,16].…”

“…Hydronephrosis is the dilatation of the pelvicalyceal system of the kidney due to different etiologies [1][2][3]. The hydronephrotic kidney may expand gradually to reach a state of marked dilatation known as giant hydronephrosis which is almost a non-functioning kidney containing > 1000 ml of fluid [4,5].…”

“…The hydronephrotic kidney may expand gradually to reach a state of marked dilatation known as giant hydronephrosis which is almost a non-functioning kidney containing > 1000 ml of fluid [4,5]. Giant hydronephrosis is rare with a few hundred case reports, and a few case series have been reported in the literature [1,2,6]. Moreover, clinically visible giant hydronephrosis is a rarer entity where cases of hydronephrosis containing > 2000 ml of fluid have been scarcely reported so far [4,7].…”