Full Description
For more than a century, the condition now known as Idiopathic Hydronephrosis has been recognised as a clinical entity, and following the original description by Rayer in 1841 a variety of procedures were devised in attempts to correct the condition surgically. Most of these early methods were introduced in the last decade of the nineteenth century by several illustrious clinicians, including Trendelenburg, KOster, Fenger and Sutton. For many years diagnosis was based purely upon the patients presenting signs and symptoms and not until the early part of this century was technology available to assist in the pre-operative diagnosis of the condition. Early methods depended upon radiological techniques, and the introduction of the retrograde pyelogram by Voelcker and Lichtenberg in 1906 represented a significant advance in diagnostic methodology. Other methods also dependent upon radiographic techniques were subsequently introduced, including urography in the late 1930s by Swick, and more recently, the method of cineradio- graphy, as pioneered with considerable success by Peter Narath in the decade following World War II.
During the past 50 years a variety of surgical procedures have been introduced for the treatment of idiopathic hydronephrosis. That so many different methods have been devised suggests that no one specific technique is capable of achieving a complete cure in all cases.
Contents
1. The Structure of the Normal and Hydronephrotic Upper Urinary Tract.- Structure of the Normal Upper Urinary Tract.- Innervation of the Upper Urinary Tract.- Functional Considerations.- Structure of the Upper Urinary Tract in Idiopathic Hydronephrosis.- Aetiological Considerations in Idiopathic Hydronephrosis.- 2. Urodynamics of the Multicalyceal Upper Urinary Tract.- Functional Activity of the Normal Upper Urinary Tract.- Physiology of the Unobstructed Upper Urinary Tract.- The Experimentally Obstructed Upper Urinary Tract.- Functional Activity of the Upper Urinary Tract in Idiopathic Hydronephrosis.- Summary of the Physiology of the Hydronephrotic Upper Urinary Tract.- 3. The Intravenous Urogram in Idiopathic Hydronephrosis.- Acute and Chronic Obstruction.- Normal and Abnormal Standard IVUs.- Clinical Judgement and the Standard IVU.- IVU Modifications.- Conclusions.- 4. Nuclear Medicine.- Parenchymal Transit Time Studies.- Diuresis Renography.- Comparison of Parenchymal Mean Transit Time with Diuresis Renography.- 5. Pressure Flow Studies I.- Clinical Application.- Technique.- Complications.- Interpretation of Results.- Indications in Equivocal Hydronephrosis.- Results of Pressure flow Measurement.- Summary.- 6. Pressure Flow Studies II.- Technique.- Interpretation.- Contraindications.- Conclusions.- 7. Experimental Validation of Diagnostic Methods.- Materials and Methods.- Results.- Discussion.- 8. Idiopathic Hydronephrosis in Children.- Morphological Anomalies.- The Renal Parenchyma.- The Opposite Kidney: Other Congenital Anomalies.- Secondary Pelviureteric Obstruction.- Complications.- Clinical Features.- Treatment.- Results.- 9. The Role of Percutaneous Nephrostomy.- Technique.- Materials.- Renal Drainage.- Retroperitoneal Drainage.- Dilatation of Operative PUJ Strictures.- Stone Dissolution.- Stone Extraction.- Complications.- Summary.- 10. Clinical Management.- Clinical Material.- Discussion.
