Hydronephrosis - Treatment 

Your treatment plan

If you have hydronephrosis, your treatment will depend on what is causing the condition and how severe the urinary blockage is. The aim of the treatment is to:

• remove the build-up of urine and relieve the pressure on your kidney(s)
• prevent permanent kidney damage
• treat the underlying cause of hydronephrosis

Most cases of hydronephrosis will need to be treated surgically using a combination of techniques (see below).

The timing of your treatment will depend on whether or not you have the symptoms of infection. If you do, there is a risk that the infection could spread into your blood. This is known as blood poisoning or sepsis and it can be very serious. In such circumstances, it may be recommended that surgery is carried out on the same day that the diagnosis is confirmed.

Immediate surgery may also be recommended if both of your kidneys are affected or if you have symptoms including severe pain, vomiting and nausea that can't be relieved with medication.

If you do not have the symptoms mentioned above, it may be considered safe to delay surgery for a few days.

Draining the urine

The first stage in treating hydronephrosis is to drain the urine out of your kidneys. This will help to ease your pain and prevent damage to your kidneys.

A thin tube called a catheter may be inserted into your bladder through your urethra (the tube through which urine is passed out of the body), or directly into your kidney through a small incision in your skin. This will allow urine to flow and relieve the pressure on the kidney.

Treating the underlying cause

Once the pressure on your kidney has been relieved, the cause of the build-up of urine must be treated. This will usually involve removing a blockage.

Blockages of the ureter (a common cause of hydronephrosis) can be treated using a type of surgery called ureteral stenting. It involves placing a small tube inside the ureter which is used to bypass the site of a blockage. The stent can be passed into the ureter (the tube that passes from the kidney to the bladder) without making major incisions in your body.

Once the urine has been drained and the ureter unblocked, the underlying cause will need to be treated to prevent hydronephrosis returning. Some possible causes and their treatments are described below.

• Kidney stones – these can be broken up using sound waves or lasers (see the Health A-Z topic about kidney stones – treatment).
• A swollen prostate – this can be treated with medication or, less commonly, surgery to remove some or all of the prostate (see the Health A-Z topic about prostate enlargement – treatment).
• Cancers – some cancers, such as cervical cancer or prostate cancer, are associated with hydronephrosis and can be treated using a combination of chemotherapy, radiotherapy and surgery to remove the diseased tissue.

If a woman's pregnancy is causing hydronephrosis, there is little that can be done to cure it other than waiting for the pregnancy to take its natural course. However, the condition can be managed by regularly draining the kidneys with a catheter throughout the pregnancy to prevent kidney damage.

Antenatal hydronephrosis

Most cases of antenatal hydronephrosis do not require any treatment because they usually resolve on their own before birth. However, frequent ultrasound scans will probably be recommended so that the extent of the swelling of the kidneys can be regularly assessed.

If hydronephrosis is present after birth, the recommended treatment will depend on the underlying cause. If your child’s hydronephrosis is due to primary vesicoureteral reflux (where the valve in their bladder does not work properly) then no immediate treatment will probably be needed. This is because most children will grow out of primary vesicoureteral reflux as they get older.

However, the urine inside their kidneys can make them more vulnerable to infection, so regular doses of antibiotic tablets may be recommended as a precaution.

Your child will need regular urine tests and ultrasound scans to monitor how they are responding to antibiotic treatment and to assess the swelling inside their kidney(s).

Surgery will be considered if your child does not grow out of primary vesicoureteral reflux, or if their hydronephrosis is severe enough to pose a threat to their health or adversely affect their quality of life.

If surgery is recommended, the surgeon can inject substances around the malfunctioning bladder valve, which should help to improve its functioning. Keyhole (laparoscopic) surgery is usually used where only small cuts are made in the skin and tiny instruments are passed through them. The advantage of this type of surgery is that it causes minimal scarring and has a quicker recovery time than traditional open surgery.

If your child’s hydronephrosis is caused by a blockage, this will need to be treated surgically in the same way as it is in adults (see above).