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Year : 2004  |  Volume : 20  |  Issue : 2  |  Page : 118-122

Giant hydronephrosis: What is the ideal treatment?

Department of Urology, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, BJ Medical College & Civil Hospital Campus, Asarwa, Ahmedabad, India

Correspondence Address:
Shailesh A Shah
Kidneyline Health Care, 1st Floor Harikrupa Towers, Near Govt. Ladies Hostel, Behind Gujarat College, Ellisbridge, Ahmedabad - 380 006
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Source of Support: None, Conflict of Interest: None

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Objectives : To formulate a strategic approach for the treatment of giant hydronephrosis based upon anatomi­cal and functional status of renal units in the individual patient. Methods : We have treated ten cases of giant hydrone­phrosis between November 1997 and December 2002. Age of the patients was in the range of 14 to 42 years. Seven were males and 3 were females. IVU revealed non-visu­alized unit of the affected side in 9 patients. One patient had bilateral hydronephrosis with azotemia. Percutane­ous nephrostomy was done in all patients as a primary procedure. The quantity of urine drained instantaneously was between 1.2 litres to 2.5 litres. Antegrade study and creatinine clearance of the affected unit was done in all. Four patients were subjected to nephrectomy. Two pa­tients underwent reduction pyeloplasty with nephropexy and 1 patient underwent primary calycoureterostomy. In two patients primary Boari flap calycovesicostomy was performed and in one patient with obstructed megaureter ureteroneocystostomy with tapering was done. Results : Two patients, in whom Boariflap ealycovesico­stomy was done, have refluxing units. They have been advised double voiding. Follow-up IVU, in 6 patients who underwent reconstructive procedure, demonstrated rea­sonable function and optimal drainage. Follow-up range is 4 months to 5 years. Conclusions: In very poorly fimctioning unit with gross infection nephrectomy is the procedure of choice. In salvageable unit, anatomical configuration should dictate the type of reconstructive procedure. In a moderately dilated extra renal system, reduction pyeloplasty with nephropexy is a reasonable option. The entirely intrarenal dilated col­lecting system is an ideal situation for calycoureterostomy. In patients with enormous calyceal dilatation Boari flap; cahvcovesicostomy ensures wide, patent, dependent drain­age.

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