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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (5): 913-918. doi: 10.19723/j.issn.1671-167X.2024.05.025

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Etiological analysis of hydronephrosis in adults: A single-center cross-sectional study

Silu CHEN1, Haiju WANG1,2, Yucai WU1, Zhihua LI1,2, Yanbo HUANG1,2, Yuhui HE1, Yangyang XU1, Xuesong LI1,*(), Hua GUAN1,2,*()   

  1. 1. Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
    2. Nursing Department, Peking University First Hospital, Beijing 100034, China
  • Received:2021-08-06 Online:2024-10-18 Published:2024-10-16
  • Contact: Xuesong LI, Hua GUAN E-mail:pineneedle@sina.com;65750628@qq.com

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Abstract:

Objective: To investigate the etiological distribution of hydronephrosis caused by upper urinary tract obstruction in adult patients and to improve the diagnostic accuracy for this condition. Methods: The clinical information of adult patients with newly diagnosed hydronephrosis in Upper Urinary Tract Repair Outpatient Clinic of Peking University First Hospital from May 2020 to May 2021 were prospectively and continuously collected. Patients with ureteral calculi or upper urinary tract tumor were excluded. A total of 767 patients were involved. The underlying causes of upper urinary tract obstruction were identified by senior urological surgeons according to symptoms, medical history, physical examination, and a range of diagnostic imaging techniques including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), retrograde pyelography, antegrade pyelography, radionuclide renogram and ureteroscopy. Results: Among the 767 patients, 359(46.8%) were male and 408(53.2%) were female. The median age of these patients was 37 years (range, 14-84 years). Hydronephrosis was observed at left-sided in 357 cases(46.6%), right-sided in 251 cases(32.7%), and bilateral in 159 cases(20.7%). The causes of hydronephrosis were classified as follows: (1) Non-iatrogenic factors were found in 464 cases (60.5%). These included urinary malformations in 355 cases(76.5%), infection in 29 cases(6.3%), pelvic lipomatosis and/or cystitis glandularis in 23 cases(5.0%), ureteral endometriosis in 18 cases(3.9%), retroperitoneal fibrosis in 15 cases(3.2%), trauma in 7 cases(1.5%) and other non-iatrogenic factors in 12 cases(2.6%). Some of these patients had multiple non-iatrogenic causes. Among the 355 cases with urinary system malformations, 252 cases (71.0%) had ureteropelvic junction obstruction. (2) Iatrogenic ureteral injuries accounted for 210 cases (27.4%), including 112 cases(53.3%) of urological surgical injuries, 51 cases(24.3%) of radiotherapy for malignant tumor related injuries, 34 cases(16.2%) of gynecological and obstetrical surgical injuries, and 13 cases(6.2%) of general surgical injuries. (3) The cause of hydronephrosis remained unknown in 93 cases(12.1%). Conclusion: Hydronephrosis in adults due to upper urinary tract obstruction has a diverse range of causes, with urinary malformations and iatrogenic ureteral injuries being significant contributors. Urological surgeon involved in upper urinary tract reconstruction should be familiar with these potential causes to facilitate accurate diagnosis and effective treatment.

Key words: Hydronephrosis, Upper urinary tract obstruction, Etiological analysis

CLC Number: 

  • R692.3

Table 1

Clinical information of patients with hydronephrosis caused by non-iatrogenic factors"

Items Urinary malformation (n=355) Infection (n=29) Pelvic lipomatosis and/or cystitis glandularis (n=23) Ureteral endometriosis (n=18) Retroperitoneal fibrosis (n=15) Parapelvic cyst (n=8) Trauma (n=7)
Gender, n (%)
    Male 186 (52.4) 10 (34.5) 22 (95.7) 0 (0.0) 7 (46.7) 2 (25.0) 7 (100.0)
    Female 169 (47.6) 19 (65.5) 1 (4.3) 18 (100.0) 8 (53.3) 6 (75.0) 0 (0.0)
Age/years, M (P25, P75) 30
(24.0, 39.0)		 35
(29.5, 51.5)		 39
(34.0, 54.0)		 44
(38.0, 50.0)		 57
(46.0, 64.0)		 60
(48.0, 68.0)		 33
(18.0, 50.0)
Location, n (%)
    Left 180 (50.7) 15 (51.7) 3 (13.0) 10 (55.6) 2 (13.3) 6 (75.0) 5 (71.4)
    Right 110 (31.0) 11 (37.9) 2 (8.7) 7 (38.9) 4 (26.7) 2 (25.0) 2 (28.6)
    Bilateral 65 (18.3) 3 (10.4) 18 (78.3) 1 (5.5) 9 (60.0) 0 (0) 0 (0.0)

Table 2

Clinical information of patients with hydronephrosis caused by urinary malformations UPJO, ureteropelvic junction obstruction"

Items UPJO (n=252) Ectopic vessel (n=35) Megaureter (n=33) Ureterostenosis (n=18) Nephroptosis(n=17) Duplex kidney (n=14) Horse-shoe kidney (n=37)
Gender, n (%)
    Male 140 (55.6) 19 (51.4) 12 (34.3) 16 (48.5) 2 (11.1) 5 (29.4) 6 (42.9)
    Female 112 (44.4) 18 (48.6) 23 (65.7) 17 (51.5) 16 (88.9) 12 (70.6) 8 (57.1)
Age/years, M (P25, P75) 30
(23.0, 38.0)		 32
(25.5, 39.5)		 29
(20.0, 41.0)		 39
(32.5, 56.5)		 31
(25.0, 39.5)		 34
(22.0, 38.5)		 34
(24.0, 48.0)
Location, n (%)
    Left 141 (55.9) 17 (46.0) 13 (37.1) 17 (51.5) 6 (33.3) 5 (29.4) 6 (42.9)
    Right 70 (27.8) 16 (43.2) 14 (40.0) 12 (36.4) 9 (50.0) 8 (47.1) 5 (35.7)
    Bilateral 41 (16.3) 4 (10.8) 8 (22.9) 4 (12.1) 3 (16.7) 4 (23.5) 3 (21.4)

Table 3

Clinical information of patients with hydronephrosis caused by iatrogenic injuries"

Items Urological operative injury (n=112) Radiotherapy injury (n=51) Gynecological and obstetrical surgical injury (n=34) General surgical injury (n=13)
Gender, n (%)
    Male 72 (64.3) 9 (17.6) 0 (0.0) 7 (53.8)
    Female 40 (35.7) 42 (82.4) 34 (100.0) 6 (46.2)
Age/years, M (P25, P75) 43.5 (35.0, 57.0) 54 (48.0, 60.0) 48 (41.5, 53.0) 52 (33.5, 56.5)
Location, n (%)
    Left 53 (47.3) 16 (31.4) 12 (35.3) 7 (53.8)
    Right 52 (46.4) 7 (13.7) 12 (35.3) 4 (30.8)
    Bilateral 7 (6.3) 28 (54.9) 10 (29.4) 2 (15.4)
1 张晓娥, 徐虹, 毕允力, 等. 单中心6年先天性肾脏和尿道畸形病因构成分析[J]. 中国循证儿科杂志, 2012, 7 (4): 263- 268.
2 Panthier F , Lareyre F , Audouin M , et al. Pelvi-ureteric junction obstruction related to crossing vessels: Vascular anatomic variations and implication for surgical approaches[J]. Int Urol Nephrol, 2018, 50 (3): 385- 394.
doi: 10.1007/s11255-017-1771-z
3 郑蒙蒙, 丁光璞, 朱伟杰, 等. 术前三维影像重建在治疗肾盂输尿管连接部梗阻中的应用[J]. 北京大学学报(医学版), 2020, 52 (4): 705- 710.
doi: 10.19723/j.issn.1671-167X.2020.04.021
4 Sanna-Cherchi S , Westland R , Ghiggeri G M , et al. Genetic basis of human congenital anomalies of the kidney and urinary tract[J]. J Clin Invest, 2018, 128 (1): 4- 15.
doi: 10.1172/JCI95300
5 江柳, 许玉峰, 唐光健. 肾结核与非结核梗阻性肾积水形态差异的影像研究[J]. 中华放射学杂志, 2018, 52 (12): 923- 926.
6 Chen Y , Yang Y , Yu W , et al. Urodynamic characteristics of pelvic lipomatosis with glandular cystitis patients correlate with morphologic alterations of the urinary system and disease severity[J]. Neurourol Urodyn, 2018, 37 (2): 758- 767.
doi: 10.1002/nau.23343
7 Zhang Y , Wu S , Xi Z , et al. Measuring diagnostic accuracy of imaging parameters in pelvic lipomatosis[J]. Eur J Radiol, 2012, 81 (11): 3107- 3114.
doi: 10.1016/j.ejrad.2012.05.031
8 Bai X , Zhang G , Xu L , et al. Diagnostic accuracy of CT imaging parameters in pelvic lipomatosis[J]. Abdom Radiol (NY), 2021, 46 (6): 2779- 2788.
doi: 10.1007/s00261-020-02946-0
9 唐天虹, 苏娜, 孙伟, 等. 盆腔脂肪增多症的超声诊断及漏误诊原因分析[J]. 中华超声影像学杂志, 2020, 29 (4): 359- 360.
10 Barra F , Scala C , Biscaldi E , et al. Ureteral endometriosis: A systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility[J]. Hum Reprod Update, 2018, 24 (6): 710- 730.
doi: 10.1093/humupd/dmy027
11 Yang K , Cheng S , Cai Y , et al. Clinical characteristics and surgical treatment of ureteral endometriosis: our experience with 40 cases[J]. BMC Womens Health, 2021, 21 (1): 206.
doi: 10.1186/s12905-021-01349-7
12 Vaglio A , Palmisano A , Alberici F , et al. Prednisone versus tamoxifen in patients with idiopathic retroperitoneal fibrosis: An open-label randomised controlled trial[J]. Lancet, 2011, 378 (9788): 338- 346.
doi: 10.1016/S0140-6736(11)60934-3
13 Vaglio A , Maritati F . Idiopathic retroperitoneal fibrosis[J]. J Am Soc Nephrol, 2016, 27 (7): 1880- 1889.
doi: 10.1681/ASN.2015101110
14 Bakir B , Yilmaz F , Turkay R , et al. Role of diffusion-weighted MR imaging in the differentiation of benign retroperitoneal fibrosis from malignant neoplasm: Preliminary study[J]. Radiology, 2014, 272 (2): 438- 445.
doi: 10.1148/radiol.14131565
15 Moroni G , Castellani M , Balzani A , et al. The value of (18)F-FDG PET/CT in the assessment of active idiopathic retroperitoneal fibrosis[J]. Eur J Nucl Med Mol Imaging, 2012, 39 (10): 1635- 1642.
doi: 10.1007/s00259-012-2144-6
16 Gild P , Kluth LA , Vetterlein MW , et al. Adult iatrogenic ureteral injury and stricture-incidence and treatment strategies[J]. Asian J Urol, 2018, 5 (2): 101- 106.
doi: 10.1016/j.ajur.2018.02.003
17 Tonolini M , Villa F , Ippolito S , et al. Cross-sectional imaging of iatrogenic complications after extracorporeal and endourological treatment of urolithiasis[J]. Insights Imaging, 2014, 5 (6): 677- 689.
doi: 10.1007/s13244-014-0355-z
18 Lebentrau S , Muller PF , Miernik A , et al. Risk factors for ureteral damage in rreteroscopic stone treatment: Results of the german prospective multicentre benchmarks of ureterorenoscopic stone treatment-results in terms of complications, quality of life, and stone-free rates project[J]. Urol Int, 2019, 102 (2): 187- 193.
19 熊盛炜, 杨昆霖, 丁光璞, 等. 输尿管损伤外科修复治疗的研究进展[J]. 北京大学学报(医学版), 2019, 51 (4): 783- 789.
doi: 10.19723/j.issn.1671-167X.2019.04.034
20 Blackwell RH , Kirshenbaum EJ , Shah AS , et al. Complications of recognized and unrecognized iatrogenic ureteral injury at time of hysterectomy: A population based analysis[J]. J Urol, 2018, 199 (6): 1540- 1545.
21 Hird AE , Nica A , Coburn NG , et al. Does prophylactic ureteric stenting at the time of colorectal surgery reduce the risk of ureteric injury? A systematic review and meta-analysis[J]. Colorectal Dis, 2021, 23 (5): 1060- 1070.
22 Wit EM , Horenblas S . Urological complications after treatment of cervical cancer[J]. Nat Rev Urol, 2014, 11 (2): 110- 117.
23 Li F , Guo H , Qiu H , et al. Urological complications after radical hysterectomy with postoperative radiotherapy and radiotherapy alone for cervical cancer[J]. Medicine (Baltimore), 2018, 97 (13): e173.
24 Welk B , Wallis C , D'Souza D , et al. A population-based assessment of urologic procedures and operations after surgery or pelvic radiation for cervical cancer[J]. Int J Gynecol Cancer, 2018, 28 (5): 989- 995.
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