What is the treatment for hydronephrosis?
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The goal of treatment for hydronephrosis is to restart the free flow of urine from the kidney and decrease the swelling and pressure that builds up and decreases kidney function.
The initial care for the patient is aimed at minimizing pain and preventing urinary tract infections. Otherwise, surgical intervention may be required.
The timing of the procedure depends upon the underlying cause of hydronephrosis and hydroureter and the associated medical conditions that may be present. For example, patients with a kidney stone may be allowed 1-2 weeks to pass the stone with only supportive pain control if urine flow is not completely blocked by the stone. If, however, the patient develops an infection or if they only have one kidney, surgical intervention may be done emergently to remove the stone.
Shock wave lithotripsy (SWL or extracorporeal shock wave lithotripsy) is the most common treatment for kidney stones in the U.S.. Shock waves from outside the body are targeted at a kidney stone causing the stone to fragment into tiny pieces that are able to be passed out of the urinary tract in the urine.
For patients with urinary retention and an enlarged bladder as a cause of hydronephrosis, bladder catheterization may be all that is needed for initial treatment. For patients with ureteral strictures or stones that are difficult to removal, a urologist may place a stent into the ureter that bypasses the obstruction and allows urine to flow from the kidney. Using a fiberoptic scope inserted through the urethra into the bladder, the urologist can visualize where the ureter enters and can thread the stent through the ureter into the kidney pelvis bypassing any obstruction.
When a stent cannot be placed, an alternative is inserting a percutaneous nephrostomy tube. A urologist or interventional radiologist uses fluoroscopy to insert a tube through the flank directly into the kidney to allow urine to drain.
Some conditions, for example retroperitoneal fibrosis or tumors, may require steroid therapy, a formal operation or laparoscopy to relieve the hydronephrosis or hydroureter while oral alkalinization therapy may be used to dissolve uric acid kidney stones.