Giant hydronephrosis in adults: What is the best approach? Retrospective analysis of 24 cases

Background: The distension of the pelvis and calyces of the kidney due to the obstruction and stasis of urinary flow or Hydronephrosis, caused by a lesion in the upper or lower urinary tract. The giant hydronephrosis (GH) is a rare entity and its etiologies are varied. Most reported cases of GH occur in infants and children, and are congenital in origin. Objectives: To formulate and validate a strategic approach for the treatment of giant hydronephrosis (GH) based upon anatomical and functional status of renal units in adults. Patients and Methods: We present a retrospective review about 24 cases of GH managed between February 2001 and February 2010. Epidemiologic data, radiological investigations, therapeutic indications, preoperative findings and follow-up were reviewed. Therapeutic indications were based upon functional status of GH. Results: The age of the patients ranged from 19 to 61 years. Ten patients were males and 14 were females. IVU revealed non-visualized unit of the affected side in 4 patients. The quantity of urine drained was between 1.1 litres and 3.5 litres. Seven patients were subjected to nephrectomy. Eight patients underwent reduction pyeloplasty. Nine patients were treated for urolithiasis. Follow-up was in the range of 9 to 73 months (mean = 32 months). Four patients had chronic renal failure requiring hemodialysis and one patient presented with recurrent pyelonephritis. Conclusions: In very poorly functioning unit, nephrectomy is the procedure of choice. In salvageable unit, anatomical configuration should dictate the type of reconstructive procedure.