Salvagability of Giant Hydronephrosis, Non-Visualised on IVU.

INTRODUCTION : . Hydronephrosis should be used as a descriptive term referring simply to the presence of dilatation of the pelvis and calyces and not to the cause of that dilatation. The presence of over 1000 ml of urine in a hydronephrotic sac in an adult is usually categorised as giant hydronephrosis. Yang et al (1958) opined that the term giant hydronephrosis should be used only when the contents of the sac equalled to average daily urine output for that age. Giant hydronephrosis has also been defined as kidney that occupies a hemiabdomen, which meets or crosses the midline and which is at least 5 vertebrae in length. Congenital ureteropelvic junction (UPJ) obstruction is the commonest cause of giant hydronephrosis in children and adults. Occasionally, it occurs as a result of ureterovesical junction obstruction. Other causes include obstructive megaureter, ureteric atresia and obstructive ectopic ureter with or without a duplex system. These Giant hydronephrosis usually present in middle age and the main therapeutic challenge is whether to go ahead with ablative or salvage procedure. All patients with giant hydronephrosis do not have similar anatomical configuration and functional status of renal units, and therefore treatment has to be individualized in every patient. Hence assessing the salvagability of these kidneys becomes all the more important. We have found that most of these cases show non excretion of contrast in IVU.Though nonvisualisation on IVU may indicate critical loss of function, the renal unit cannot be branded as “Nonfunctional”. AIM AND OBJECTIVE : 1. To assess the salvagability of Giant hydronephrosis, non visualized on IVU,using percutaneous nephrostomy. 2. To compare various parameters used to estimate the recoverability of renal function. MATERIAL AND METHODS : Period of study – Aug 2005 to May 2008 (34 months), No. of patients studied – 24, No.of Bilateral PUJO – 1, No. of unilateral PUJO -23, Male : female = 12:12, Right : left = 11 : 13, Age range from 13-46 years (average 26 years). Inclusion criteria : 1. All giant hydronephrosis, non visualized on IVU. 2. Patients counseled and patients giving consent for PCN were selected for study. 3. patients, who did not consent for PCN underwent nephrectomy. CONCLUSION : Although PUJ obstruction is usually a congenital obstruction, it commonly manifests in middle age. Salvagability of kidney after chronic obstruction has been extensively studied in pediatric population. Renal changes after ureteric obstruction has been studied extensively in animal models ,especially in acute setting. Extrapolation of these findings to adult setting has its own disadavantages. All the regular parameters like cortical thickness, compensatory hypertrophy, Diuretic renogram, Resistive index are not without pitfalls. Predicting the salvagability of chronically obstructed kidneys based on single parameter or combined parameters can be misleading. Percutaneous nephrostomy is a simple, objective assessment of the kidney function. In our study, it has altered the management in 38% of patients. Based on our analysis, it can be safely concluded that Percutaneous nephrostomy is a useful tool in accurate assessment of chronically obstructed kidneys