Obstructive Uropathy

The term hydronephrosis stems from Greek meaning “water kidney condition.” Hydronephrosis is the result of inadequate drainage of urine relative to the amount of urine produced by the kidney. This imbalance between flow into the kidney and flow out of the kidney results in swelling within the urinary collecting system. Causes of hydronephrosis can be classified into functional and obstructive etiologies. Leading causes in adults include pregnancy, urolithiasis, stricture, urothelial carcinoma, urinary tract infection, and neurogenic bladder. The clinical symptoms associated with hydronephrosis can often be attributed to the underlying etiology but most often manifest as flank pain. Untreated hydronephrosis can lead to infection and acute and chronic renal injury, and therefore, timely decompression of the distended urinary collecting system is the mainstay of treatment today. With continued innovation in materials science and imaging physics, minimally invasive interventional techniques provide an excellent option for addressing this uropathy. Percutaneous nephrostomy has become a key treatment for hydronephrosis as a minimally invasive urinary diverting procedure which limits hydronephrosis-associated renal injury, allows for the clearance of infected urine, and can offer additional time for medical optimization of patients prior to more invasive therapies. An understanding of the principal concepts in pre-procedural planning, procedural steps, and postprocedural care is critical to delivering safe and effective care to a patient with hydronephrosis.