Purpose: To study the incidence, clinical presentations and outcomes of giant hydronephrosis in adults along with review of literature. Materials and Methods: 3 patients of giant hydronephrosis were included in the study. Patients underwent clinical examination, all routine investigations, CT scan of abdomen and diuretic renal scan. Results: All renal units were non–functional and patients underwent nephrectomy after initial percutaneous nephrostomy. One emergency was performed in view of haematuria with clots. Conclusion: UPJ Obstruction is most common cause of GH and kidney usually becomes non–functional at presentation. Abdominal lump is most common presentation. Timely intervention in adults can prevent further complications before patients undergoing nephrectomy. Management of GH is a two–step process including initial decompression by nephrostomy followed by nephrectomy