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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana-Archivio per le Scienze Mediche 2009 June;168(3):207-10
Giant hydronephrosis secondary to ureteropelvic junction obstruction
Aguiar M. F. M., Oliveira A. P. S., Silva S. C., Bernardes J. G. B., Fonseca R. C.
Section of Urology, João de Barros Barreto University Hospital, Federal University of Pará Belém, Brazil
Giant hydronephrosis is defined as the presence of over 1000 mL of liquid within the urinary collector system. It is usually secondary to ureteropelvic junction obstruction, lithiasis or congenital abnormality. As clinical presentation is unpredictable and usually initially asymptomatic, diagnosis may be postponed thus leading to a kidney mass which could appear with clinical features of abdominal organs compression (bowel or urinary obstruction) or simulate abdominal tumors, massive ascites, or cystic retroperitoneal lesions. Someti-mes, arterial hypertension, dyspepsia and signs of venous compression are also presented. Nephrectomy is the gold standard for the treatment of giant hydronephrosis and it must be considered if a permanent and severe lost of renal function is present (<10%), or in case of complications as infection (pyonephrosis) or renal rupture due to blunt trauma. We present a case of giant hydronephrosis secondary to ureteropelvic junction obstruction. Nephrecto-my through a laparotomic approach was performed, evacuating 17 L of liquid from the pyelocalicial system. The patient has been hospitalized for four days, with maintenance of contralateral renal function after one-year follow-up. Its slow evolution, associated with difficulties to access the public health care in Brazil could have been the reason for the diagnostic and medical management delay.