Chen Silu, Wang Haiju, Wu Yucai, Li Zhihua, Huang Yanbo, He Yuhui, Xu Yangyang, Li Xuesong, Guan Hua
Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China.
Nursing Department, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Oct 18;56(5):913-918. doi: 10.19723/j.issn.1671-167X.2024.05.025.
To investigate the etiological distribution of hydronephrosis caused by upper urinary tract obstruction in adult patients and to improve the diagnostic accuracy for this condition.
The clinical information of adult patients with newly diagnosed hydronephrosis in Upper Urinary Tract Repair Outpatient Clinic of Peking University First Hospital from May 2020 to May 2021 were prospectively and continuously collected. Patients with ureteral calculi or upper urinary tract tumor were excluded. A total of 767 patients were involved. The underlying causes of upper urinary tract obstruction were identified by senior urological surgeons according to symptoms, medical history, physical examination, and a range of diagnostic imaging techniques including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), retrograde pyelography, antegrade pyelography, radionuclide renogram and ureteroscopy.
Among the 767 patients, 359(46.8%) were male and 408(53.2%) were female. The median age of these patients was 37 years (range, 14-84 years). Hydronephrosis was observed at left-sided in 357 cases(46.6%), right-sided in 251 cases(32.7%), and bilateral in 159 cases(20.7%). The causes of hydronephrosis were classified as follows: (1) Non-iatrogenic factors were found in 464 cases (60.5%). These included urinary malformations in 355 cases(76.5%), infection in 29 cases(6.3%), pelvic lipomatosis and/or cystitis glandularis in 23 cases(5.0%), ureteral endometriosis in 18 cases(3.9%), retroperitoneal fibrosis in 15 cases(3.2%), trauma in 7 cases(1.5%) and other non-iatrogenic factors in 12 cases(2.6%). Some of these patients had multiple non-iatrogenic causes. Among the 355 cases with urinary system malformations, 252 cases (71.0%) had ureteropelvic junction obstruction. (2) Iatrogenic ureteral injuries accounted for 210 cases (27.4%), including 112 cases(53.3%) of urological surgical injuries, 51 cases(24.3%) of radiotherapy for malignant tumor related injuries, 34 cases(16.2%) of gynecological and obstetrical surgical injuries, and 13 cases(6.2%) of general surgical injuries. (3) The cause of hydronephrosis remained unknown in 93 cases(12.1%).
Hydronephrosis in adults due to upper urinary tract obstruction has a diverse range of causes, with urinary malformations and iatrogenic ureteral injuries being significant contributors. Urological surgeon involved in upper urinary tract reconstruction should be familiar with these potential causes to facilitate accurate diagnosis and effective treatment.
探讨成年患者上尿路梗阻所致肾积水的病因分布情况，并提高对此病症的诊断准确性。
前瞻性、连续性收集2020年5月至2021年5月在北京大学第一医院上尿路修复门诊新诊断为肾积水的成年患者的临床资料。排除输尿管结石或上尿路肿瘤患者。共纳入767例患者。由资深泌尿外科医生根据症状、病史、体格检查以及一系列诊断性影像学技术，包括超声、计算机断层扫描（CT）、磁共振成像（MRI）、逆行肾盂造影、顺行肾盂造影、放射性核素肾图和输尿管镜检查，确定上尿路梗阻的潜在病因。
767例患者中，男性359例（46.8%），女性408例（53.2%）。这些患者的中位年龄为37岁（范围14 - 84岁）。肾积水见于左侧357例（46.6%），右侧251例（32.7%），双侧159例（20.7%）。肾积水的病因分类如下：（1）464例（60.5%）为非医源性因素。其中包括泌尿系统畸形355例（76.5%）、感染29例（6.3%）、盆腔脂肪增多症和/或腺性膀胱炎23例（5.0%）、输尿管子宫内膜异位症18例（3.9%）、腹膜后纤维化15例（3.2%）、创伤7例（1.5%）以及其他非医源性因素12例（2.6%）。部分患者有多种非医源性病因。在355例泌尿系统畸形患者中，252例（71.0%）存在肾盂输尿管连接部梗阻。（2）医源性输尿管损伤210例（27.4%），包括泌尿外科手术损伤112例（53.3%）、恶性肿瘤放疗相关损伤51例（24.3%）、妇产科手术损伤34例（16.2%）、普通外科手术损伤13例（6.2%）。（3）93例（12.1%）肾积水病因不明。
成年患者上尿路梗阻所致肾积水病因多样，泌尿系统畸形和医源性输尿管损伤是主要原因。参与上尿路重建的泌尿外科医生应熟悉这些潜在病因，以利于准确诊断和有效治疗。
