The Conservative Treatment Of The Severe Hydronephrosis

BACKGROUND OF RESEARCHHydronephrosis is one of the most common disease in the urologic system. Obstruction of any part of urologic system will cause the difficulty of drainage of renal pelvis and finally lead to hydronephrosis. Nowadays the treatment of the severe hydronephrosis is the focus in the study of the hydronephrosis. We collected 41 cases of severe hydronephrosis in the urologic department of the First Affiliated Hospital of Medical College of Zhejiang University in the last 5 years who have been treated conservatively. We not only followed up them after the treatment but also analyze their diagnosis and treatment. Besides, we studied some kidney samples of patients under light microscope and electronic microscope respectively. Our purpose is to summarize the successful experience and can offer some references to clinic surgeons so that maybe they can deal with such patients more reasonably in the future.CLINIC DATA&METHODWe collected 41 cases of severe hydronephrosis in the urologic department of the First Affiliated Hospital of Medical College of Zhejiang University in the last 5 years who have been treated conservatively. We followed up them, generally analyzed their clinic manifestation, diagnosis, treatment, kinds of surgery and prognosis. What's more, we further studied some kidney samples under the light microscope and electronic microscope. HE routine dye was used in the light microscope, the electronic microscope with routine transmission electronic microscope.RESULTSThere were 39 patients followed up completely and only 2 patients lost of follow-up. In the 39 patients who were followed up, the renal functions of 27 patients have been recovered or improved while those of other 12 patients have not recovered or have been operated the nephroectomy in other hospitals including one patient death from renal failure. The statistic analysis shows us that the prognosis of the younger patients with severe hydronephrosis is better than that of the elder. Second, there are no obvious statistic differences between the prognosis of the patients whose renal parenchyma is less than 0.5cm in ultrasonic and that of more than 0.5cm. Third, there are no obvious statistic differences between the patients whose IVP developed no images and those developing images. Fourth, the patients who received the surgerys of Anderson-Hynes have better prognosis than those who received the other analogical plastic surgeries. We also find that there are some normal nephrons under the light microscope and a great deal of collagenous fiber of the PUJ obstruction part under the electronic microscope.CONCLUSION1. The younger of the patient with severe hydronephrosis, the more chances of the better prognosis.2. The ultrasonic and IVP can not been used as accurate methods to forecast the prognosis of the patients with severe hydronephrosis.3. The surgery of Anderson-Hynes should been used as the best choice of the PUJ plastic surgery in the patients with severe hydronephrosis.4. It is possible to recover the renal function of the patients with special severe hydronephrosis through nephrostomy.5. It may be the pathologic basis of some patient's recover after the surgery as we can observe some normal nephrons under the light microscope.