[Ways of improving the surgical treatment of hydronephrosis]

There are two important aspects in hydronephrosis as a clinical problem: while specialized diagnostic techniques are well-developed, early detection of the disease remains unsatisfactory. Surgery ends in primary nephrectomy in 15-20% of the cases. As many nephrectomies are performed following earlier plastic operations. The reason for this is not only the atypical course of early hydronephrosis or the absence of pathognomonic symptoms. Only 45% of 100 patients undergoing primary nephrectomy for hydronephrosis showed atypical early developments, while the remaining 55% had repeatedly sought medical help for 2 to 16 years. Yet they had only stayed in hospital until painful attacks were controlled, and undergone no or incomplete urologic investigations. Early diagnosis and treatment of congenital defects at large, and hydronephrosis in particular, can only be improved, provided all preschool and school children are subject to preventive ultrasonic screening, and those with suspected congenital defects such as hydronephrosis are referred for combined urologic investigation and subsequent treatment or observation at specialized urologic centres, furnished with specific equipment, instruments and sutures. The surgical method and techniques are very important for the improvement of the surgical outcome. Of the great variety of operations proposed for hydronephrosis, those that eliminate obstruction to urinary flow and, at the same time, bring into conformity the calyceal and pelvic volumes have proved to be the best. Those include the Andersen-Hynes operation, Calp- de Vird operation, tubuloplasty, PUS resection, latero-lateral anastomosis, resection of the lower and upper ends of the kidney with its pelvis if hydronephrosis is complicated by calicectasis.