79-Year-Old Man Diagnosed with Hydronephrosis Caused by Ureteral Mass: A Case Study
Summary: A 79-year-old male presented to our hospital with sudden-onset right-sided flank and abdominal pain. Imaging revealed a mass in the distal right ureter causing significant bilateral hydronephrosis—fluid buildup in both kidneys due to urinary obstruction. Through minimally invasive endoscopic procedures, including cystoscopy and ureteroscopy, the obstructing lesion was successfully removed and a ureteral stent was placed to restore urine flow. Post-surgery, the patient experienced rapid symptom relief and progressive improvement in kidney function, highlighting the importance of timely diagnosis and intervention in elderly patients presenting with unexplained flank pain.
Patient Overview
Gender & Age: Male, 79 years oldDiagnosis: Bilateral hydronephrosis secondary to ureteral massHospital: The First Affiliated Hospital of Xi'an Jiaotong UniversityDate of Admission: May 2022Treatment Plan: Endoscopic surgery (cystoscopy, ureteroscopy), ureteral stent placement, and intravenous antibiotic therapy using Cefuroxime Sodium for infection preventionDuration of Treatment: 10-day inpatient stay followed by scheduled outpatient follow-upOutcome: Complete resolution of pain and marked improvement in renal function as confirmed by imaging
Initial Clinical Evaluation
The patient arrived at the emergency department complaining of persistent right flank and lower abdominal pain that had begun abruptly one day prior. He also reported nausea but denied fever, dysuria, or visible blood in his urine. On physical examination, he appeared alert and oriented, with stable vital signs. Abdominal palpation showed no tenderness, rebound pain, or guarding. However, percussion over the right renal angle elicited moderate discomfort—a key clinical clue pointing toward possible kidney involvement.
To further investigate, we ordered a non-contrast computed tomography (CT) scan of the abdomen and pelvis. The results were striking: there was clear evidence of bilateral pelvic dilation indicating hydronephrosis, particularly severe on the right side. Additionally, a dense soft-tissue density was observed along the course of the distal right ureter, accompanied by localized thickening of the ureteral wall. These findings strongly suggested an obstructive etiology caused by a ureteral mass. Given the risk of progressive kidney damage, immediate hospitalization was recommended, which the patient accepted.
Treatment Approach and Surgical Intervention
Once admitted, we discussed the case thoroughly with the patient and his family. We explained that the root cause of his symptoms was likely mechanical blockage from the ureteral growth, preventing normal urine drainage from the kidneys. To confirm this and treat it simultaneously, we proposed a dual diagnostic-therapeutic approach using cystoscopy and ureteroscopy under general anesthesia.
Procedure Details
On the second day of admission, the procedure was performed. Using a flexible cystoscope, we accessed the bladder and then advanced a ureteroscope into the right ureter. Upon reaching the lower segment, we encountered a narrowed area with inflamed, hyperplastic mucosa and rigid walls—making traditional biopsy unsafe due to bleeding risks. Instead of forceful sampling, we opted for conservative management: placing a double-J ureteral stent to bypass the obstruction and allow free passage of urine from the kidney to the bladder.
During the same session, abnormal tissue was carefully extracted and sent for histopathological analysis. The lab results later revealed predominantly neutrophilic infiltration without any malignant cells—indicating an inflammatory rather than cancerous origin. This ruled out urothelial carcinoma, a common concern in older adults with ureteral masses.
Postoperative Care
Following the procedure, the patient returned to the ward in stable condition. Intravenous Cefuroxime Sodium was administered twice daily for five days to prevent post-procedural infections. Pain levels decreased significantly within 48 hours, allowing him to ambulate independently. By day seven, his recovery was sufficient to remove the urinary catheter, after which he resumed spontaneous voiding without difficulty.
Follow-Up and Recovery Progress
A repeat CT scan before discharge showed substantial reduction in hydronephrosis bilaterally, confirming restored urinary flow. After ten days of monitoring and supportive care, the patient was discharged home with detailed instructions for ongoing recovery.
At the two-month follow-up visit, another CT scan demonstrated near-complete resolution of kidney swelling, with no residual mass or new abnormalities detected. The patient remained asymptomatic, with no recurrence of pain, urinary issues, or systemic signs of infection.
Key Recommendations for Patients with Ureteral Stents
As the treating physician, I emphasized several crucial points during discharge counseling to ensure long-term success and prevent complications:
1. Monitor for Urinary Symptoms
Watch closely for warning signs such as increased urinary frequency, urgency, burning sensation during urination, or hematuria (blood in the urine). Any of these may indicate stent irritation, infection, or displacement and should prompt immediate medical evaluation.
2. Adopt a Kidney-Friendly Diet
Patients recovering from obstructive uropathy should follow a low-sodium, low-fat, and moderate-protein diet. Avoid spicy, processed, or highly acidic foods that can irritate the bladder. Staying well-hydrated is essential—aim for at least 1.5 to 2 liters of water per day unless otherwise restricted by your doctor.
3. Limit Physical Strain
Heavy lifting, intense exercise, or actions that increase intra-abdominal pressure—like deep squats, straining during bowel movements, or forceful coughing—can dislodge the stent. It's best to avoid strenuous activities until the stent is removed and full healing occurs.
4. Maintain Genital Hygiene
To reduce the risk of urinary tract infections (UTIs), maintain excellent personal hygiene. Wear loose-fitting, breathable cotton underwear and clean the genital area daily with warm water. Avoid harsh soaps or scented wipes that could disrupt natural flora.
5. Attend All Follow-Up Appointments
Regular check-ups are critical to monitor kidney function, assess stent position via imaging, and determine when it's safe to remove the device. Blood tests, urinalysis, and periodic ultrasounds or CT scans help track progress and catch early signs of recurrence.
Clinical Insights: Why Early Detection Matters
This case underscores a vital principle in geriatric urology: unexplained flank or abdominal pain in older adults should never be dismissed as musculoskeletal strain. While back pain is common with aging, underlying urological causes like ureteral strictures, stones, or tumors must be ruled out promptly.
Hydronephrosis develops when urine cannot drain properly from the kidneys, leading to increased intrarenal pressure and potential loss of kidney function. If left untreated, chronic obstruction can result in irreversible renal damage or even end-stage kidney disease. In this instance, the ureteral mass—though benign in nature—was acting as a "functional dam," blocking urine flow and threatening kidney health.
Luckily, thanks to early imaging and minimally invasive intervention, we were able to relieve the obstruction quickly and preserve renal function. Modern endourological techniques like ureteroscopy offer a safe, effective alternative to open surgery, especially for high-risk elderly patients.
In conclusion, this successful outcome highlights the value of proactive symptom reporting, accurate diagnostics, and timely surgical intervention. For clinicians, it reinforces the need to consider obstructive uropathy in differential diagnoses for elderly patients with abdominal discomfort. For patients and families, it serves as a reminder: listen to your body, seek care early, and trust in modern medicine's ability to resolve complex conditions—even in advanced age.