Review on Congenital Hydronephrosis due to Ureteral Obstruction

Park, Moo Nam

Abstract

A clinical observation was made on the 20 cases of congenital hydronephrosis due to ureteral obstruction confirmed by pathological report or operation finding of the patients admitted to Severance Hospital during from 1965 to September 1971, and the followings were obtained: 1) The rate of congenital hydronephrosis accounted for 1.3 per cent of the total patient admitted to the Department of Urology, and 23.6 per cent of total patients with hydronephrosis during the period of seven years. 2) Fifteen cases were in male and only five cases in female. The distribution of age was between 2 and 1/2 years and 61 years, but the most common age was below 10 years as 6 cases of total cases. 3) The incidence of pathological side was more in the left side than the right and also two cases rare bilatera1. The pathological site of etiological factor was found near uretero-pelvic area chiefly, as 15 cases in upper one third, 6 cases lower one third, 1 case in body of ureter. 4) The symptoms on admission were flank pain in 50 per cent of total patients, palpable mass in 35 per cent, hematuria in 30 per cent, G-I trouble in 10 per cent, respiratory distress in one case, no symptom in one case. 5) The underlying causes were composed of intrinsic factor in 14 cases (63%), of which 3 cases were combined with aberrant vessel, and extrinsic factor in the remainder. Also one case of fibrous band combined with aberrant vessel was found. 6) The degree of hydronephrosis was determined by urography, pathological and operation finding, and according to these findings, grade 3 (advanced case) was prominent as rate of 54.3% of total cases and grade I (mild case) was only 18.0% of total cases. 7) The incidence of the associated disease in G-U tract of congenital hydronephrosis was 31. 5% of total cases, 6 cases in ipsilateral kidney and 1 case in opposite kidney. 8) On laboratory examination, abnormal finding in urinalysis was found in 60% of total cases and bacteriuria in urine culture was seen in 6 cases (30%) of total, of which 3 cases were infected with E. coli. Also, BUN was increased in 5 cases (25%), but highest level was 52mg% 9) In cases of impossibility to recover in view of renal function, the nephrectomy or uretero-nephroctomy was performed in 11 cases of total and plastic repair was performed in 4 cases as resection with oblique reanastomosis in 2 cases, Fenger's operation in one case, and Foley Y pyelo-ureteroplasty in one case. Besides above procedures, following: one was performed; ureterolysis in 4 cases, 5 cases in division of aberrant vessel, and 2 cases in ureteroneocystostomy. 19) As postoperative complication, continuous urinary leakage was seen in one case of 4 cases which plastic repair was performed and renal hypertension 3 months after operation developed in one cases of 5 cases which aberrant vessel was cut.