Quick Question - Vesicoureteric reflux v. Hydronephrosis?

[Jack P]

Hi...this is one of those chicken or egg questions but I just wanted to clear it up in my head and would appreciate any response.

If lets say you have a young person with no neoplastic pathology with unilateral hydronephrosis, one makes the diagnosis of VUR as the cause of the hydronephrosis. However, if you have an older person with an invasive cervical squamous cell CA that extends laterally to block one ureter causing an obstruction leading to unilateral hydronephrosis, do you also have VUR or is it just hydronephrosis from the obstruction? Is VUR its own specific pathology or can it also be related to obstruction with concominant reflux?

Thanks....

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[Ratch]

Unilateral hydro in a kiddo can be a couple of things; but if you are assuming its VUR then realize that this is a specific pathology related to how the ureter enters the bladder, what angle it enters at, how far it tunnels through the submucosa and muscularis, etc. VUR is a specific pathology (refluxing urine) that results in hydro.

Obstruction is simply a process of urine not being able to get out. its not refluxing, it just can't get out. plain and simple. this results in stasis and predisposes for infection, kills you kidneys, etc etc etc... obstruction is a stone or bph most likely, but these are not pathologies that typically result in reflux.

Just realize that obstruction and reflux are not the same thing. reflux results when you have a poorly developed valve mechanism in the area where the ureter joins the bladder. normally when your bladder fills the muscularis compresses the ureter and stops reflux, while peristalsis allows for urine movement down. if this is deficient, you get reflux. but even when this mechanism is crappy, your urine is still flowing and you are obstruction free.

hydro is always a manifestation of something else (l another example might be extravasation of contrast on an abdominal CT) - there is something else causing it to occur.

hope that helps

 

[Jack P]

Thanks Ratch...I was convinced that obstruction was just stasis and that VUR is its own pathology but I've come across a few questions that have checked my confidence. In some way I was thinking that obstruction could lead to stasis and reverse peristalsis of the fluid with resulting hydronephrosis, but I guess obstruction is just like plugging a hole, there's no outlet yet you continue to produce urine with the backup destroying the kidney. Thanks for the explanation, I can see clearly now...