Genito Urinary Case 3: Hydronephroses / Obstructive disease

Hydronephrosis means dilatation of renal collecting system and renal pelvis. It may be either secondary to obstruction or due to reflux.

Commonest cause for obstruction is calculi. The common sites of obstruction are:

• in the ureter at the ureteo vesical junction (most common).
• Uretero pelvic junction
• along the ureter .

Other causes for obstruction are:

• BPH: Large bladder may produce hydronephrosis which may completely disappear after voiding or catheterization.
• Cancer Prostate: By involvement of the urethra, or by pressure on the ureters by nodes.
• Bladder neoplasm
• Urethral obstruction
• Pelvic masses
• Retroperitoneal fibrosis

Non obstructive Dilatation: Common cause is ureteral reflux

Findings in CT & IVP:

• Kidney size is variable
• Parenchymal thickness is reduced
• Nephrogram may be normal or decreased
• Large dilated fluid filled calyces may be seen with rims outlined by contrast
• Dilated ureter

Findings in Ultrasound:

• Dilatation of calyces and pelvis
• Renal parenchymal thickness decreased
• Renal resistance measured by duplex doppler index is elevated
• Urinary jet absent on obstructed side (demonstrated by color doppler)

Case 1: Right Uretero vescical stone

• KUB:  Image 
• Ultrasound: Image     Image 
• CT: Image     Image    Image 

Case 2: Cancer Prostate

• CT:    Image     Image

Case 3: Posterior Urethral valve

• Ultrasound: Image     Image      Image

Case 4: BPH

• Image     Image

Case 5: Aortic aneurysm with left Hydronephroses

• Image