1. Hydronephrosis (Grading)
Society of Fetal Urology (SFU)Grading System
Grade 0 No splitting of the central renal echo complex
Grade I Slight splitting of the central renal echo complex
Grade II Dilated renal pelvis and some fluid in calyces
Grade III Pelvis dilated beyond sinus, calyces uniformly dilated
Grade IV Pelvis and calyces dilated, parenchyma thin
Mild hydronephrosis (Grade I or II)
Moderate hydronephrosis (Grade III)
Severe hydronephrosis ( Grade IV)
Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol. 1993;23:478-80

2. Treatment (Medical)
The role of medical treatment is limited to pain control and treatment or prevention of infection
Most conditions require either minimally invasive or open surgical treatment.
Two notable exceptions are
(1) oral alkalinization therapy for uric acid stones and
(2) steroid therapy for retroperitoneal fibrosis
Vourganti, S. (2008). Hydronephrosis and Hydroureter: Treatment & Medication

3. Treatment (Medical)
Neonates with hydronephrosis are at high risk for pyelonephrosis
Therefore, all neonates diagnosed with unilateral or bilateral hydronephrosis should be started on antibiotic prophylaxis
Example: Amoxicillin 10 mg/kg per 24 h
Schwartz’s Manual of Surgery 8th Ed.

4. Treatment (Surgical)
The specific treatment of a patient with hydronephrosis depends on the etiology of the process
Any signs of infection within the obstructed system warrant urgent intervention because infection with hydronephrosis may progress rapidly to sepsis
The potential for loss of renal function also adds to the urgency
Vourganti, S. (2008). Hydronephrosis and Hydroureter: Treatment & Medication

5. Treatment (Surgical)
Urethral catheterization to help rule out a lower tract cause for hydronephrosis and hydroureter
Difficulty in placing a Foley catheter may suggest urethral stricture or bladder neck contracture
Ureteral stent placement in cases of intrinsic and extrinsic causes of hydronephrosis.
Stents can bypass an obstruction and dilate the ureter for subsequent endoscopic treatment
Vourganti, S. (2008). Hydronephrosis and Hydroureter: Treatment & Medication

6. Treatment (Surgical) Nephrostomy tube
Using the Seldinger technique, a tube ranging from 8-12F can be placed
Placed when a retrograde stent cannot be passed because of anatomic changes in the bladder or high-grade obstruction in the ureter
Vourganti, S. (2008). Hydronephrosis and Hydroureter: Treatment & Medication

7. Treatment (Surgical)
Advances in endoscopic and percutaneous instrumentation have decreased the role of open or laparoscopic surgery for hydronephrosis.
However, extrinsic causes of hydropnephrosis (retroperitoneal fibrosis, retroperitoneal tumors, and aortic aneurysms) still require treatment with open surgery.
Some stones that cannot be treated endoscopically or with extracorporeal shockwave lithotripsy require open removal
Vourganti, S. (2008). Hydronephrosis and Hydroureter: Treatment & Medication