Elderly Man, 79, Diagnosed with Hydronephrosis Caused by Ureteral Mass

Hydronephrosis, a condition characterized by the swelling of one or both kidneys due to a buildup of urine, can develop silently and lead to serious complications if left untreated. In this case study, a 79-year-old male presented with sudden-onset right flank pain and was ultimately diagnosed with bilateral hydronephrosis caused by an obstructive mass in the right ureter. Thanks to timely diagnosis and minimally invasive surgical intervention, the patient made a full recovery with significant improvement in kidney function and symptom relief.

Patient Overview

Age & Gender: 79-year-old maleDiagnosis: Bilateral hydronephrosis secondary to right ureteral massHospital: The First Affiliated Hospital of Xi'an Jiaotong UniversityDate of Admission: May 2022Treatment Plan: Endoscopic surgery (cystoscopy and ureteroscopy) with ureteral stent placement, followed by intravenous antibiotic therapy using Cefuroxime Sodium for infection preventionDuration of Treatment: 10-day hospitalization with scheduled follow-up visits

Initial Presentation and Diagnosis

The patient arrived at the clinic complaining of persistent right-sided flank and abdominal pain that had started abruptly one day prior, accompanied by nausea. Physical examination revealed no signs of generalized illness—mental status was clear, abdomen soft without tenderness or rebound pain, and no lower limb edema was observed. However, there was notable tenderness upon percussion over the right renal area, suggesting possible kidney involvement.

To investigate further, a CT scan was performed. Imaging results showed a dense lesion behind the distal segment of the right ureter, localized thickening of the ureteral wall, moderate perirenal fluid-like changes on the right side, and bilateral dilation of the renal pelvis—clear indicators of urinary tract obstruction leading to hydronephrosis. Based on these findings, the clinical team concluded that the root cause was likely a ureteral mass obstructing normal urine flow. The patient was advised to be admitted for definitive treatment, which he accepted willingly.

Diagnostic and Therapeutic Intervention

Upon admission, after discussing the risks and benefits, the patient consented to undergo cystoscopy and ureteroscopy under general anesthesia. The procedure took place two days later. During endoscopic evaluation, severe narrowing of the distal right ureter was noted, with hyperplastic mucosal tissue and rigid walls preventing safe biopsy collection.

Surgical Approach and Immediate Outcomes

Given the degree of obstruction, the surgical team opted to insert a double-J ureteral stent to restore urine drainage and relieve pressure on the kidneys. A catheter was temporarily placed, and abnormal tissue samples were collected for histopathological analysis. Laboratory testing revealed predominantly neutrophilic infiltration with no evidence of malignant cells, ruling out cancer as the underlying cause at that stage.

Postoperatively, the patient received intravenous Cefuroxime Sodium to prevent potential infections. He remained stable throughout recovery, with no signs of bleeding, fever, or systemic complications.

Recovery and Follow-Up Results

Symptom improvement began within 48 hours—flank pain significantly decreased, allowing the patient to walk independently. By day seven, his overall condition had stabilized sufficiently to allow removal of the urinary catheter, after which he resumed normal voiding without difficulty.

A repeat CT scan before discharge confirmed marked reduction in kidney swelling, indicating successful decompression of the urinary system. Two months post-surgery, follow-up imaging showed no residual abnormalities, and the patient reported complete resolution of symptoms, confirming a positive long-term outcome.

Key Post-Discharge Recommendations

To support sustained recovery and prevent recurrence or complications, the medical team provided the following guidance:

• Monitor Urinary Symptoms: Report any new onset of frequent urination, urgency, dysuria, or hematuria immediately for prompt evaluation.
• Dietary Modifications: Adopt a kidney-friendly diet low in salt, fat, and protein. Avoid spicy and irritating foods that may stress the urinary tract.
• Physical Activity Guidance: Prioritize rest and avoid heavy lifting or strenuous activities. Steer clear of actions that increase intra-abdominal pressure—such as deep squatting or forceful coughing—which could dislodge the stent.
• Personal Hygiene: Maintain cleanliness of the genital area. Wear loose-fitting, breathable cotton underwear and clean the perineum daily with warm water to minimize infection risk.
• Follow-Up Compliance: Attend all scheduled outpatient appointments to monitor kidney function, assess stent position (if still in place), and ensure continued progress.

Clinical Insights and Takeaways

This case underscores the importance of early detection and targeted intervention in managing obstructive uropathy. Hydronephrosis often develops gradually and may present with nonspecific symptoms such as flank pain or gastrointestinal discomfort, making it easy to overlook. However, identifying the source of urinary blockage—whether from stones, strictures, or masses—is critical for preserving renal function.

In this instance, the ureteral mass, though benign in initial pathology, created significant mechanical obstruction. Prompt placement of a ureteral stent not only relieved symptoms but also protected kidney health during recovery. Minimally invasive techniques like ureteroscopy offer effective diagnostic and therapeutic solutions with faster recovery times compared to open surgery.

Final Note: For older adults experiencing unexplained back or abdominal pain, especially when associated with urinary changes, seeking timely urological assessment can make a crucial difference. Early imaging and specialist referral can prevent irreversible kidney damage and improve quality of life.