I have studied 68 patients with hydronephrosis. Except when complicated by infection, calculosis, cancer and severe strictures, function at excretory urography was relatively good even in advanced cases of hydronephrosis. In Zambia, Central Africa the intensity of infection and the disordered ureteral motility are the most important factors in the pathogenesis of bilharzial hydronephrosis. In other countries strictures, calculosis, ureteroceles, vesicoureteral reflux and bladder cancer apparently are more significant in these cases. Since reimplantation of the ureters usually fails because of fibrosis conservative treatment is advocated with periodic dilation of troublesome stricture(s). This is especially true since supra-infection is rare even after repeated surgical procedures. The importance of geographical variations of the disease and the relevance to clinical management are stressed.
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