The treatment of hydronephrosis is centred on relieving the obstruction and preserving kidney function. Since the condition itself is usually a symptom of an underlying issue, effective treatment of hydronephrosis must also target the root cause. Management strategies vary based on the severity of the swelling, whether one or both kidneys are involved, the duration of the condition, and the patient’s overall health status.
Mild cases may go away on their own or with simple care, while moderate to severe hydronephrosis usually needs medicine or surgery. Early treatment matters a lot to stop long-term harm, especially when urine drainage is fully blocked or when infection happens. Quick action can restore normal urine flow and greatly improve results.
Conservative Management
Sometimes, especially with mild and symptom-free hydronephrosis, a gentle approach works best.
- Watchful Waiting: For antenatal hydronephrosis or pregnancy-related cases, the swelling often goes away after birth or soon after.
- Hydration and Monitoring: Drinking enough fluids helps kidneys work well and keeps urine flowing. Doctors check progress with regular ultrasounds and blood tests.
- Lifestyle Changes: Avoiding heavy lifting and cutting down on salt can ease pressure on the kidneys when surgery isn’t needed.
This conservative management suits patients who are stable and show no infection or worsening kidney problems.
Medical Treatment
Medicine is often the first choice when infection or inflammation is present, or when kidney stones are small enough to pass naturally.
- Antibiotics: If there is a urinary tract infection (UTI), doctors give targeted antibiotics. Sometimes children get antibiotics to stop infections from coming back.
- Pain Relief: Painkillers like ibuprofen or stronger medicines can ease pain from stones or blockage.
- Alpha Blockers: Drugs like tamsulosin relax the ureter muscles, helping stones pass and reducing blockage.
- Diuretics: Sometimes used when urine flow is poor or if heart failure adds to hydronephrosis.
Medicine alone can fix the problem if the cause is temporary or expected to clear up without surgery.
Interventional Procedures
If medicine does not work well enough, doctors may use small procedures to help urine flow or lower pressure in the kidneys.
- Ureteral Stent: A thin tube goes into the ureter to keep it open and let urine pass to the bladder. This often serves as a temporary fix before surgery.
- Nephrostomy Tube: When the ureter is fully blocked or the patient is very ill, a tube is put directly into the kidney through the back to drain urine outside the body.
- Percutaneous Nephrostolithotomy: Large kidney stones are removed through a small cut in the back, especially when other treatments fail.
These procedures usually happen under local or general anaesthesia and use imaging tools like ultrasound to guide them.
Surgical Treatment
Surgery is needed when less invasive methods cannot fix the problem or when structural defects must be corrected.
- Pyeloplasty: Surgery to rebuild the junction between the kidney and ureter. It removes the narrow part and joins healthy ends. This treats blockages present from birth or developed later.
- Ureteral Reimplantation: Mostly done in children with urine flowing the wrong way or blocked ureters. The ureter is moved to ensure urine flows one way into the bladder.
- Prostate Surgery: Older men with enlarged prostate causing blockage may have surgery like TURP to improve urine flow and reduce hydronephrosis.
- Stone Removal: Depending on size and place, stones can be taken out using ureteroscopy, shock wave therapy, or open surgery.
After surgery, doctors watch patients closely and do imaging tests to confirm the swelling has gone.
Treatment in Special Populations
Some groups need special care due to their unique risks or body changes.
- Pregnancy: Hydronephrosis often gets better without treatment. If pain or symptoms are bad, a ureteral stent might be needed. Doctors use imaging without radiation and pick medicines safe for the baby.
- Infants and Children: Treatment focuses on fixing birth defects. Careful monitoring, early surgery, and infection control help protect kidney health.
- Elderly Patients: Older adults often need gentler treatment. Fixing prostate enlargement, bladder problems, or ureter narrowing is important.
Tailored care ensures every patient gets the safest and most effective treatment.
Follow-Up and Monitoring
Long-term success depends on regular check-ups. Problems can come back or cause hidden damage even after treatment.
- Regular Imaging: Follow-up ultrasounds or scans check that urine drains well and kidneys stay healthy.
- Kidney Function Tests: Blood tests should repeat to watch creatinine, urea, and eGFR levels.
- Infection Watch: People with past hydronephrosis and repeated UTIs need close monitoring for new infections.
- Stent or Tube Care: Temporary devices must be removed or replaced on time to avoid infection or blockages.
Ongoing care is very important for patients with urinary problems or chronic kidney disease.
Summary
The treatment of hydronephrosis depends on the cause and how bad the blockage is. Mild cases may improve with simple care and fluids, while others need medicine, drainage procedures, or surgery. The goal is always to lower pressure on the kidneys, restore normal urine flow, and avoid lasting damage.
Thanks to modern tools and many treatment options, most people with hydronephrosis can expect good results — as long as care is fast and complete. Checking regularly after treatment helps find any problems early.
