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 obstruc- tion 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 investi- gations, 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 sub- jected 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 reconstruc- tive procedure.