Multiple Percutaneous Drainage of a Giant Pyonephrosis Caused by Urolithiasis: A Case Report.

The prevalence of kidney stones continues to rise in modern times. Undiagnosed and/or mistreated, it can result in suppurative kidney damage and, in rare instances, death from systemic infection. We present the case of a 40-year-old woman who presented to the county hospital for sleight left lumbar pain, fever, and pyuria for about two weeks. Ultrasound and CT scan revealed a giant hydronephrosis with no visible parenchyma, secondary to a stone in the pelvic-ureteral junction. Although a nephrostomy stent was placed, 48 hours later the purulent content was not evacuated completely. She was referred to a tertiary center, where two more nephrostomy tubes were placed to completely evacuate approximately 3 L of purulent urine. Three weeks later, after the inflammation parameters normalized, a nephrectomy was performed with good outcomes. A pyonephrosis urologic emergency can develop into septic shock, demanding rapid medical attention to prevent potentially fatal outcomes. In some circumstances, percutaneous draining of a purulent collection may not be sufficient to remove the whole purulent mass. Before nephrectomy, all collections must be removed with further percutaneous procedures.

Giant right hydronephrosis with underlying double malignancy: a case report.

Giant hydronephrosis is mostly caused by ureteropelvic junction obstruction (UPJO). Giant hydronephrosis with concurrent malignancy is less common clinically and is easily misdiagnosed. We report a 77-year-old male who presented with sudden onset progressive abdominal distension in the last month. Abdominal computed tomography showed a right severe hydronephrotic kidney with loss of parenchymal thinning. Cystoscopy showed a 1x1cm papillary lesion protruding from the right ureteric orifice. He underwent a right radical nephroureterectomy with bladder cuff excision with lymph node dissection. Histopathology showed low-grade urothelial carcinoma of the ureter and incidental pleomorphic rhabdomyosarcoma in the right kidney. The patient refused chemotherapy and died 6 months later due to lung metastasis. Incidental pathologic finding of renal rhabdomyosarcoma in adults with giant hydronephrosis and urothelial carcinoma is a rare occurrence with diverse clinical presentations, prognoses, and outcomes.

Giant hydronephrosis masquerading as ovarian tumor: a case report.

Giant hydronephrosis is defined as the accumulation of more than 1 l of fluid in the kidney's collecting system. Its presentation can mimic other conditions including ovarian tumor. Herein, the authors report a case of giant hydronephrosis caused by urolithiasis that mimics the presentation of an ovarian tumor. The authors also highlight the challenges in diagnosing this rare entity and the management options available. Case presentation: The authors present a case of a 65-year-old P5A0 woman with an abdominal tumor of 1-year duration that progressively increased in size. She also complained of mild left flank pain since a year ago. Ultrasonography revealed a large cystic mass in the lower to middle abdomen. Ovarian tumor was suspected and laparotomy was performed. Surgical exploration revealed a left giant hydronephrosis with normal gynecological organs. The postoperative course was uneventful, and she was discharged in satisfactory condition. Clinical discussion: Giant hydronephrosis should always be considered as a differential diagnosis when presented with a large abdominal cystic lesion. Conclusion: Routine screening for bilateral kidneys during gynecological ultrasonography will help detect giant hydronephrosis and prevent unplanned surgical interventions.

Giant Hydronephrosis: A Rare Case Report and Literature Review.

Giant hydronephrosis (GH), characterized by the presence of more than 1 L of fluid in the renal collecting system, is a rare urological condition, particularly in adults. Obstruction of the pyeloureteral junction is the most common cause of GH. We report the case of a 51-year-old man who presented with dyspnea, edema of the lower limbs, and major abdominal distension. The patient was diagnosed with obstruction of the pyeloureteral junction, causing a left giant hydronephrotic kidney. After renal drainage of 27 L of urine, a laparoscopic nephrectomy was performed. GH usually manifests as asymptomatic abdominal distension or vague symptoms. However, very few published reports describe cases of GH initially presenting with respiratory and vascular manifestations.

Giant Bilateral Hydronephrosis in A Newborn-A Case Report.

BACKGROUND: Prenatal hydronephrosis is common and may vary in size. Although mostly unproblematic, it may be a sign of urinary tract obstruction of differing severity. CASE DIAGNOSIS/TREATMENT: We present a boy with prenatally detected bilateral giant hydronephrosis. A prenatal ultrasound showed the whole abdominal cavity of the fetus filled with urine. Kidney parenchyma could not be seen. The boy was born at 34 + 1 weeks' gestation. After delivery, he showed a severely distended abdomen. Insertion of a nasogastric tube was not possible, and he had to be intubated due to respiratory distress. A bilateral percutaneous nephrostomy was performed immediately. After a few hours, he could be stabilized and extubated. An ultrasound on the following day showed two kidney units with normal kidney parenchyma of normal size. The initially slightly elevated serum creatinine level normalized within one week. An antegrade pyelography via the nephrostomy tubes showed bilateral ureteropelvic junction obstruction. CONCLUSION: Severe bilateral hydronephrosis may be associated with good outcome and well-preserved kidney function. Prenatal counseling should be done carefully, with discussion of different treatment possibilities and without definitive prediction of outcome.

Acute abdominal pain localized in right iliac fossa: Not always acute appendicitis. A case of giant hydronephrosis in an 8-year-old boy and literature overview.

Abdominal pain is a frequent complaint in children, leading them to seek medical attention. It can have several causes, though acute appendicitis is the most feared diagnosis when pain is localized in the right iliac fossa. We report a case of an 8-year-old boy with the complaint of acute abdominal pain, initially referred by his family doctor to a radiologist for an abdominal ultrasound (US) for suspected acute appendicitis. A fortuitous diagnosis of giant hydronephrosis (GH) was made upon admission, which showed the palpation of a huge poorly delineated abdominal mass that was probably missed at the previous examination by the general physician (GP). Uroscan confirmed the diagnosis of GH secondary to obstruction at the ureteropelvic junction. A renal MAG3 (mercaptuacetyltriglycine) scan showed revealed differential renal function (15%) on the right side, normal on the left side. Robot-assisted right pyeloplasty with the transposition of right lower polar vessels via trans-peritoneal laparoscopy was performed, and JJ probe left in-situ for a month. The boy is doing well and is under active follow-up. GH is rare; its diagnosis requires both meticulous examination and a high index of suspicion. Its management is uncodified but in children, pyeloplasty is preferred to nephrectomy.

Perinatal Management in a Pregnant Woman with Ureteropelvic Junction Obstruction: Case Report and Literature Review.

Although giant hydronephrosis (GH) associated with ureteropelvic junction obstruction (UPJO) is extremely rarely detected in pregnant women, diagnostic methods, therapeutic approaches, and perinatal management have not been established. A 31-year-old Japanese primipara had a 15 cm × 12 cm multi-cystic mass in the right abdomen detected by transabdominal ultrasound at gestational week 26. Magnetic resonance imaging revealed that the mass was right renal GH. She underwent serial ultrasound-guided transretroperitoneal drainage as conservative treatment. She delivered vaginally at gestational week 36. Since she had flank pain and a documented non-functional right kidney, laparoscopic nephrectomy was conducted 22 months after delivery. UPJO with fewer smooth muscle cells and fibrosis was histologically diagnosed in the surgical specimen. Her postpartum and postoperative courses were uneventful for 10 months. We performed a literature review of diagnostic methods, clinical characteristics, and perinatal management in pregnant women with GH due to UPJO.

Visual impression of the colon over giant hydronephrosis in a child: A case report.

INTRODUCTION: Giant hydronephrosis is a rare manifestation of upper urinary tract obstruction. On clinical examination, a colonic band of resonance is appreciated on percussion due to presence of transverse colon anterior to the renal lump. However, visualizing the colon on inspection is not reported in the literature. PRESENTATION OF CASE: A 13-year-old girl presented with abdomen distension for a duration of two years. On clinical examination, the abdomen was grossly distended, with left side of abdomen more prominent. On inspection, the colonic impression was visualized. There was large cystic lump, above which, the colonic impression was observed. With percussion we could elicit the colonic band of resonance as well. Imaging and radionuclide scan revealed giant hydronephrosis of left kidney with poor function. Patient underwent a laparoscopic nephrectomy. Patient was discharged after 3 days. CONCLUSION: Giant hydronephrosis can present as gross abdomen distension. The presence of colon anterior to the renal lump can be appreciated by inspection during the clinical examination.

Transperitoneal laparoscopic simple nephrectomy for giant hydronephrosis: Tips and tricks to make it easier.

PURPOSE: We report our experience with transperitoneal laparoscopic nephrectomy (LN) for giant hydronephrosis (GH) and compare the outcome data with open nephrectomy (ON). PATIENTS AND METHODS: The retrospective data of 88 patients (52 males and 36 females) who underwent LN or ON for treatment of GH in the period between October 2015 and December 2019 were investigated. LN was performed in 38 patients, while 50 patients underwent ON. We compared the two groups for success, operative time, and intraoperative and postoperative complications. RESULTS: The mean age of the patients in the LN group was 45.8 ± 11.4 years, and it was 44.7 ± 10.8 years in the ON group. The mean operative time in the LN group was statistically significantly longer when compared with the ON group195 ± 18 min versus 127 ± 22 min (p = 0.01).The estimated blood loss was significantly greater in the ON group (p = 0.01). However, no patients required blood transfusions in either group. The visual analog pain (VAP) scores were significantly higher on both day 1 and day 2 in the ON group 3.6 ± 0.9 and 2 ± 0.7 versus 2.7 ± 0.6 and 1.4 ± 0.5 in LN group, (p = 0.01). CONCLUSION: LN for GH is feasible, safe, and efficacious. Compared to open surgery, the laparoscopic approach resulted in significantly shorter hospital stays, decreased morbidity, and quicker recovery. Some tips and tricks could help to do it in an easier way and reduce the operative time.

Hypertension secondary to abdominal mass

Secondary arterial hypertension (HTN) can be caused by primary hyperaldosteronism, renovascular disease, sleep apnea syndrome, chronic kidney disease, drug use, etc. In addition, some urological disorders such as hydronephrosis can cause hypertension due to an increase in intraglomerular pressure that activates the renin angiotensin system.(AU)

La hipertensión arterial (HTA) secundaria engloba un amplio diagnóstico diferencial que incluye causas tan distintas como el hiperaldosteronismo primario, la enfermedad renovascular, el síndrome de apnea del sueño, la enfermedad renal crónica, el consumo de fármacos, etc. Existen, además, ciertos trastornos urológicos como la hidronefrosis que pueden producir HTA debido a un aumento de presión intraglomerular que active el sistema renina-angiotensina.(AU)

Giant hydronephrosis complicated by multiple uroepithelial carcinomas.

Giant hydronephrosis is uncommon, and malignant hydronephrosis of unknown origin is even rarer. We report a case of a 43-year-old male patient with giant hydronephrosis without painless carnivorous hematuria. Preoperative imaging and urinary search for exfoliated cells revealed no evidence of renal pelvic cancer. The patient underwent simple nephrectomy and pathology confirmed the diagnosis of multifocal high-grade papillary uroepithelial carcinoma of the renal pelvis.

Hypertension secondary to abdominal mass.

Secondary arterial hypertension (HTN) can be caused by primary hyperaldosteronism, renovascular disease, sleep apnea syndrome, chronic kidney disease, drug use, etc. In addition, some urological disorders such as hydronephrosis can cause hypertension due to an increase in intraglomerular pressure that activates the renin angiotensin system.

Minimally invasive management of massive giant hydronephrosis in tertiary care centre Northern Sri Lanka: A case report.

INTRODUCTION & IMPORTANCE: Giant hydronephrosis (GH) is defined as a kidney containing greater than 1000 ml of urine in its collecting system. It is a rarely presented condition in an adult. Common aetiology for GH is due to congenital ureteropelvic junction obstruction. We present a case of a late presentation of GH was being managed by a minimally invasive laparoscopic technique. CASE PRESENTATION: A 63-year-old Sri Lankan male presented with worsening of generalized abdominal swelling with vague abdominal symptoms for a six-month duration, found to have a GH of the left kidney on USS. The Contrast-enhanced computerized tomography (CECT) scan confirmed the diagnosis with 12l of fluid and possible ureteropelvic junction obstruction (UPJO). CT did not show any excretion of the left kidney. Hydronephrosis was drained one day before the surgery by a percutaneous nephrostomy tube. Laparoscopic transperitoneal nephrectomy was performed. The patient had a smooth and fast recovery. DISCUSSION: A neglected congenital UPJO can present with GH in adults. It causes vague abdominal symptoms like abdominal distension, dyspepsia, and fatigue. CECT will give the diagnosis and identify the aetiology of GH. Non-functional GH kidneys can be treated with nephrectomy by open or laparoscopic surgical technique. Laparoscopic nephrectomy shoes less blood loss during surgery, less postoperative pain and early recovery after surgery. However, in GH, surgeons need the experience to overcome the challenges like adhesions and working in a small space. CONCLUSIONS: The percutaneous nephrostomy decompression followed by laparoscopic transperitoneal nephrectomy is feasible for a massive GH.

Giant hydronephrosis secondary to ureteropelvic junction obstruction, a rare occurrence, case report.

Giant hydronephrosis (GH) is very rare in adults. We report a case of a 46-year-old man who presented with progressively increasing abdominal swelling. A contrast-enhanced CT scan of the abdomen and pelvis was used for the diagnosis. Left side open nephrectomy was performed and 22 L fluid was evacuated. UPJ obstruction was noted intraoperatively. No recurrence of abdominal swelling was noted on follow up examination.

Giant hydronephrosis associated with angiomyolipoma in an adult male: A case report.

Giant Hydronephrosis in the adult can reach elephantoid proportions, containing several liters of fluid. It can be associated with rare renal neoplasms. We present a 27 year old man with progressive painless abdominal distention whose imaging investigations (ultrasound and CT scan) disclosed a left GH. This was successfully removed en-bloc by simple nephrectomy via a midline laparotomy. Obstruction was at the UPJ, the mass contained 13.5L of fluid and histopathologic examination revealed Angiomyolipoma of the kidney and pelvis. This is a rare discovery in a rare pathology.

Giant hydronephrosis secondary to ureteral calculi in adults: Case report and literature review.

Giant hydronephrosis is rare to be seen in adults and is often the cause of misdiagnosis, It is usually caused by ureteropelvic junction syndrome. We here report the unusual case of a patient hospitalized with giant hydronephrosis secondary to ureteral calculi, associated with impaired general condition. Diagnosis was based on CT scan. The patient underwent deferred nephrectomy after percutaneous drainage.

Adult giant hydronephrosis diagnosed in the second trimester of pregnancy: A case report and literature review.

Adult giant hydronephrosis in a normally sited kidney is unusual during pregnancy. The most frequent cause is congenital obstruction at the ureteropelvic junction. Ultrasound accompanied by magnetic resonance imaging (MRI) are valuable in reaching the diagnosis, especially when clinical assessment of an abdominal mass is inconclusive regarding aetiology. We report a case of giant hydronephrosis in a woman who presented at 23 weeks of gestation with abdominal distension. She was managed conservatively. Unfortunately, the pregnancy was complicated by severe pre-eclampsia at 32 weeks of gestation, necessitating delivery via emergency caesarean section. She had a smooth postpartum recovery, and subsequently standard imaging was performed before nephrectomy. The literature and previously reported cases of giant hydronephrosis in pregnancy are reviewed.

Hidronefrosis gigante: a propósito de dos casos con distintas etologías / Giant hydronephrosis: about two cases with different etologies

La hidronefrosis gigante se considera una entidad rara, caracterizada por la presencia de al menos 1 litro de líquido dentro del sistema pielocalicial, más frecuente en pacientes masculinos, generalmente asintomático. Se presenta el caso de una paciente femenina de 85 años de edad quien refiere desde hace 6 años dolor lumbar izquierdo y aumento de la circunferencia abdominal; en la TAC abdomino-pélvica contrastada se evidencia bolsa hidronefrótica izquierda gigante con corteza renal adelgazada que no concentra ni elimina el contraste. Se presenta el caso de paciente masculino de 85 años de edad quien refiere desde hace 5 años aumento de la circunferencia abdominal y la TAC abdomino-pélvica contrastada muestra importante dilatación del riñón y sistema colector derecho secundario a litiasis ureteral. A ambos pacientes se les practicó nefrectomía simple. Con respecto a la hidronefrosis gigante, la etiología más frecuente es la estenosis de la unión ureteropélvica seguido por la patología litiásica y tumoral; es importante considerar esta entidad como diagnóstico diferencial en caso de masas quísticas abdominales(AU)

Giant hydronephrosis is considered a rare entity, characterized by the presence of at least 1 liter of fluid within the pielocalicial system; is more frequent in males and often asymptomatic. We present an 85-year-old female patient who has a 6-year complain of left lumbar pain associated with increase in abdominal circumference. On CT scan, a giant left hydronephrotic pouch is evidenced, with a thinned renal wall that does not concentrate or eliminate contrast. We present a 61 year-old male who refers a 5-year asymptomatic increase in abdominal circumference. The CT scan reveals significant dilatation of the kidney and right collecting system secondary to ureteral lithiasis. Both patients undergo simple nephrectomy. The most frequent etiology of giant hydronephrosis is ureteropelvic junction stenosis followed by lithiasic and tumor pathology. It is important to consider this entity as a differential diagnosis in the case of abdominal cystic masses(AU)