Secondary hydronephrosis in young men presenting with lower urinary tract symptoms: Results of the SciCOM 3 project

Abstract

Introduction: Secondary hydronephrosis is an uncommon but potentially serious complication of lower urinary tract dysfunction. This study examines clinical associations of young men with lower urinary tract symptoms (LUTS) presenting with hydronephrosis. Methods: Secondary analysis of multicentric study examining young men presenting with LUTS. LUTS, stool consistency, sexual dysfunction, bladder pain, nonbladder myofascial pain, perception of problems related to the bladder, and general well-being were captured by questionnaires along with basic clinical data. Hydronephrosis was presumed to be secondary to lower urinary tract dysfunction if there was ureteric dilatation, it was asymptomatic, and there was no other reason based on clinical judgment. Results: Hydronephrosis was noted in 26/442 men (5.9%). Men with hydronephrosis had lower body mass index (BMI), longer duration of symptoms, larger postvoid residual (PVR), and were more likely to be diabetic and/or have a history of urinary infection (all P < 0.05). Association was noted with need to strain, reduced strength of stream, sense of incomplete evacuation, urgency, and urgency incontinence (all P < 0.05). On multivariate logistic regression analysis, BMI (P = 0.007) and PVR (P = 0.010) were independently associated. One-unit reduction in BMI was associated with 30% increase in odds of hydronephrosis, while 100 ml increase in PVR was associated with 82% increase. Receiver operator curve analysis yielded BMI ≤23 and PVR ≥80 ml as predictive of hydronephrosis. Conclusions: Secondary hydronephrosis is seen in a small number of young men with LUTS. Such men show a distinct clinical profile that can offer clinical clues useful in the algorithm for evaluation. © 2025 Indian Journal of Urology.