Hydroureter - Causes, Symptoms, Diagnosis, and Management

Introduction

Hydroureter is a common entity usually encountered in primary health care, emergency medical care, nephrology, and urology medical practices. The urinary system is a multi-complex organ system that primarily maintains the body’s physiological balance by regulating the pressure and volume of body fluid, electrolyte balance, and excreting metabolic waste products through an end product called urine. Anatomically, the urinary system comprises the kidneys, ureters, urinary bladder, and urethra. Each kidney is divided into an outer cortex and an inner medulla that form renal pyramids, extending into the kidney pelvis that is continued as the ureter.

Hydroureter can be present independently, or it can be presented together with hydronephrosis (dilatation of the collecting duct of the kidneys due to prevention of urine outflow because of some blockage distal to the kidney pelvis). It may occur in all age groups. The clinical presentation can be acute or chronic, physiologic (as seen in pregnant women), pathologic, unilateral, or sometimes bilateral.

What Is Hydroureter?

Hydroureter is a condition that develops when the ureter (its function is to transport urine from the kidneys to the urinary bladder) enlarges in size more than normal due to a backup of urine because of some blockage. Hydroureter can occur with other urinary tract problems, but it can also be present as the only condition in an individual.

What Are the Causes of Hydroureter?

In some cases, the etiology is unknown. However, the causes can be either intrinsic or extrinsic.

Intrinsic Causes:

• Kidney stones.

• Cancer of the kidneys.

• Renal cysts.

• Stenosis of the ureteropelvic junction (an obstruction that connects the renal pelvis (a kidney part) to one of the ureters.

• Chronic inflammation.

• Posterior urethral valves (an obstructive membrane that develops in the urethra, responsible for draining the urine from the urinary bladder). The valve often blocks the flow of urine through the urethra outside.

• Benign prostatic hyperplasia (prostate gland enlargement).

• Neurogenic bladder (the messages transmitted back and forth through the nerves between the spinal cord and urinary bladder are damaged, disrupting its function).

Extrinsic Causes:

• Pregnancy.

• Peripelvic cysts (kidney cysts that are located peripherally until they enlarge in size to impinge upon the kidneys).

• Retrocaval ureter (a rare anomaly present since birth where the ureter passes posterior to the inferior vena cava).

• Malignancy (cancer).

• Trauma to the kidneys.

• Retroperitoneal fibrosis (a rare disorder marked by the presence of inflammatory fibrous granulation tissue in the retroperitoneum).

• A prostate abscess (acute infection of the prostate gland).

What Are the Clinical Symptoms and Signs of Hydroureter?

The clinical symptoms mainly include the following:

• Loss of appetite.

• Frequent occurrence of urinary tract infections.

• Constant dull pain that can become severe at times.

• Nausea and vomiting.

• Dysuria (painful urination).

• Abdominal pain.

• Fever.

The clinical signs of hydroureter observed include the following:

• Swollen ureters.

• Swollen, enlarged kidneys (hydronephrosis).

• Decreased amniotic fluid volume around the baby in the gestational age (oligohydramnios).

• Pulmonary hypoplasia (incomplete development of the lungs).

How Is the Diagnosis of Hydroureter Made?

• Ultrasound- The condition of hydroureter can be usually detected at the routine 20-week ultrasound. The healthcare provider can perform many ultrasounds to check if the condition improves or worsens. Usually, the ultrasounds are done every four to five weeks to keep an eye on the ureters and measure the volume of amniotic fluid.

• Amniocentesis- It is a test usually done during pregnancy to check if the baby is suffering from any chromosomal disorder. It may be done sometimes. Here, the amniotic fluid is withdrawn from the amniotic sac in the mother’s belly and sent for testing for other problems. After birth, an ultrasound of the urinary bladder, ureters, and kidneys can be done on the child to check the problem. This is done to check the flow of urine through the urinary system.

• Urinalysis- Since the patients are more prone to urinary tract infections, it is important to do a urinalysis.

What Is the Management of Hydroureter?

The management of hydroureter depends on other medical conditions of the patient. It often goes away on its own before birth or within the initial months post-birth. If the condition worsens after birth, the baby might be put under clinical observation in the hospital for a few more days.

• Surgery: Surgery is usually carried out to treat the condition. This is usually done in the baby's first year or two. However, this treatment usually depends on the type of blockage.

• Antibiotic Prophylaxis: Antibiotics are usually prescribed to prevent the occurrence of urinary tract infections in elderly patients because they are more prone to such infections.

• Cystoscopy-Guided Ureteral Stent Placement: For the stent placement, the ureteral hole where the ureter enters into the urinary bladder on the affected is identified and evaluated. A wire is inserted into the orifice to reach up through the ureter to guide through the inside of the kidney. A ureteral stent is placed over the wire and progresses into the kidneys.

What Are the Complications of Hydroureter?

Reduced amniotic fluid volume in the fetus's gestational age (oligohydramnios) is a possible complication with hydroureter. This can also affect the normal lung development of the baby. The umbilical cord can narrow down, limiting or cutting off the baby’s blood, nutrients, and oxygen supply. Urinary tract infection is another complication that can lead to infections of the kidneys. It can further progress to pyelonephritis (an inflammatory condition of the kidney caused due to a bacterial infection). It is an infection of the kidney that requires hospitalization. Patients may develop post-obstructive diuresis (an abnormal disorder of prolonged discharge of excessive quantity of urine) when a chronic obstruction is relieved.

Conclusion

Hydroureter is a clinical condition that is frequently encountered in almost all age groups. It is very crucial to promptly identify the etiology of the condition to treat the disease. For babies suffering from hydroureter that does not resolve on its own, surgery is the only solution that can fix the issue. Specialist doctors like nephrologists and urologists should be involved in managing the disease. A soft diet should be taken to prevent the occurrence of renal stones. Close monitoring of the patient with frequent follow-ups is required to prevent severe kidney dysfunction.