Урология - Hydronephrosis

Nephroptosis – differential diagnosis

Distopia of kidney – kidney doesn’t come back to the hypochondrium when the patient is in horisontal position, short taut ureter, renal arteries are placed lover than normally.

In case of haematuria – with renal tumor

Abdominal tumors, splenomegalia, ovarial cysts.

Treatment

 Conservative	 Surgical
 wearing of bandage,	 nephropexia
 Physiotherapy exercises

Nephroptosis –indications for surgical treatment

pain, chronic pyelonephritis with often exacerbations, atrerial hypertension, fornical bleeding, hydronephrosis

Varicocele

Varicocele means varicosity of the veins of the spermatic cord.

The veins become dilated, elongated and tortuous.

The veins of the spermatic cord include the pampiniform plexus i.e. testicular veins and the cremasteric veins.

Surgical anatomy

Veins of the spermatic cord include 3 groups of veins:

1.Veins draining the testis and epididymis

2.Veins accompanying the vas deferens

3.Veins of the cremasteric muscle

Causes

1.Majority of the cases are idiopathic and no definite cause can be detected.

2.Tall, thin men are prone to develop this

condition.

3. As the left testicular vein drains into the left renal vein at right angle, some obstruction at the place of drainage is expected.

4.Sometimes the left testicular artery arches the left renal vein and may obstruct it.

5.Sometimes cremasteric veins become dilated which freely communicate with the pampiniform plexus and drain into the inferior epigastric veins.

6.Varicocele may be secondary to renal cell carcinoma of the left kidney. So sudden onset of varicocele in middle aged man should arouse suspicion of a renal cell carcinoma.

Complications

Atrophy of testis

Infertility

Varicocele and spermatogenesis

Varicocele increases temperature in the scrotum and this seriously depresses spermatogenesis.