Ureterocele in women: causes, symptoms, early diagnosis, treatment methods. Causes, symptoms and treatment of ureterocele in women Diagnosis of ureterocele

The first description of the ureterocele belongs to Lechler and refers to 1834. This anomaly was discovered during the autopsy, but Lechler considered it to be double bladder.

In 1961, Uson, Lattimer, Melich found that ureterocele often occurs when the kidneys are doubled.

A ureterocele may also be accompanied by ectopic ureteral orifice (an atypical location), duplication of the ureters, infection, and ureterocele stone formation.

When doubling the top urinary tract ureterocele in most cases is detected in the ureter of the upper half.

This pathology is detected at any age and accounts for 1-2% of cases of the total population.

Ureterocele in men is less common than in women (1:2-2.5).

Ureterocele in children occurs with a frequency of 1:500 newborns.

Forms

Pathology can be both congenital and acquired.

Depending on the location of the ureterocele, there may be:

• intravesical (protrusion is localized in the cavity Bladder and has many options)
• extravesical (occurs when the ureter flows into the genitals, urethra or paraurethral).

Although common classification ureterocele has not yet been developed, allocate:

• Simple (orthotopic) ureterocele, which can be unilateral or bilateral. Expansion of the ureter with this type of ureterocele is observed directly in the bladder. In most cases, it is small in size, but can be combined with compression of the adjacent ureter in the presence of its doubling or with compression of the contralateral ureter.
• Ectopic ureterocele, which is accompanied by the penetration of part of the ureter into the urethra or into the neck of the bladder. It occurs at a low level of ectopia of the ureteral orifice, is large in size and can compress the orifices of the contralateral and main ureters.

Depending on the degree of development of the pathology, there are:

• I degree, in which the intravesical ureter is slightly expanded, and there are no functional changes in the renal cavity system;
• II degree, in which the expansion of the ureter leads to the accumulation of urine and the development of ureterohydronephrosis;
• III degree, in which, in addition to ureterohydronephrosis, there are significant dysfunctions of the bladder.

Reasons for development

The cause of ureterocele can be:

• Congenital anomaly of the structure distal ureter (deficiency of muscle fibers in the area included in the wall of the bladder), which leads to lengthening of the intramural segment, or congenital narrowing of the mouth of the ureter.
• Blockage of the mouth of the ureter (occurs during the formation of kidney stones and their migration into the ureter, etc.).

If the structure of the wall layers in the lower part of the ureter is disturbed and its opening is narrowed, the pressure in the ureter increases, and the ureter wall is stretched.

The resulting expansion, wedged between the layers of the bladder wall, exfoliates its wall and forms a cavity that contains urine.

The ureterocele increases at regular intervals when filled with urine, and decreases when urine is ejected through the orifice of the ureter.

Pathogenesis

An increase in hydrostatic pressure in the ureter and overstretching of its wall leads to its bulging into the intravesical section of the bladder.

The ureterocele may be small in size and manifest only as frequent urination, but with a significant size, the ureterocele protrudes into the ureter and obstructs the outflow of urine from one of the kidneys.

When the volume of the ureter is limited, frequent urination with a small amount of urine is observed.

With a significant size of the ureterocele in women and girls, there may be a noticeable descent of the protrusion into the urethra, even from the outside. In such cases, acute or chronic urinary retention develops.

In violation of the process of urination in renal pelvis there is stagnation of urine (hydronephrosis), infection with microbes occurs and cystitis and pyelonephritis develop. These processes contribute to the formation of urinary stones, and subsequently lead to nephrosclerosis and the loss of kidney function.

In any variant of the pathology, the Weigert-Meyer law is not violated - when the ureter is doubled, the orifice of the ureter of the upper pelvis is located in the bladder medially and below the orifice of the ureter of the lower pelvis.

When doubling the ureters, many combinations are revealed different options this protrusion and ectopia of the mouths of the ureters, but with a high ectopia of the mouth of the ureter, the ureterocele is never localized in the main ureter.

With an ectopic ureterocele, a low ectopia of the orifice of the ureter is always detected, and the intramural ureter is absent.

A simple ureterocele is localized in the corner of the vesical triangle (in the place of the normal location of the ureteral orifice), and the intramural section is preserved.

Symptoms

A ureterocele is often asymptomatic until pyelonephritis develops. The development of this complication is accompanied by:

• an increase in body temperature;
• change in color and transparency of urine (becomes cloudy and dark, up to a shade of "meat slops");
• pain in the lumbar region, accompanied by a feeling of fullness in the side.

With ureterocele, infectious diseases of the urinary system often occur, frequent urination and imperative (sudden and irresistible) urge to urinate are observed.

Pus may be present in the urine, and in some cases, blood.

With a large size of the protrusion and its descent into the urethra, urinary incontinence is observed. In women, this prolapse can lead to complete urinary retention.

With a total violation of the outflow of urine from the kidneys and the development of acute hydronephrosis, there are paroxysmal pains similar to renal colic.

Diagnostics

In most cases, a ureterocele is detected during the examination due to recurrent urinary tract infections.

A general urinalysis in this pathology reveals the presence of leukocytes, erythrocytes and pus, and bacteriological examination allows us to detect the microflora that is characteristic of urinary infections.

Conducted ultrasound of the bladder allows you to detect a rounded thin-walled liquid formation protruding on the wall of the bladder. Ultrasound of the kidneys in most cases reveals unilateral or bilateral hydronephrotic transformation of the organ.

Cystography gives a clear x-ray picture of the ureterocele. Radiographs can reveal vesicoureteral reflux into the adjacent and opposite ureter, the presence of a defect in the filling of the bladder and club-shaped expansion of the distal ureter (sometimes ectopia is detected).

To determine the degree of violation of the outflow of urine, excretory urography is used, in which a contrast agent is injected into a vein.

Uroflowmetry measures the rate of urine flow during urination.

The mouths of the ureters and the mucous membrane of the bladder are examined in detail using cystoscopy, for which a special optical device is inserted through the urethra.

Treatment

Since mechanical obstruction of the ureter often occurs with this pathology, removal of the ureterocele is performed to eliminate the blockage.

To remove an orthotopic protrusion long time transvesical excision was used, which was combined with antireflux surgery, however, with small and medium-sized protrusions, endoscopic removal of the ureterocele is now preferred.

Endoscopic removal is performed using electroincision, endosurgical scissors or a holmium laser. The operation includes two stages - first, the wall of the ureterocele is dissected and, in the presence of a stone, ureterolithotripsy is performed, and then the reconstructive-plastic stage of the operation is performed.

With large protrusions and ectopic protrusions, endoscopic surgery does not justify itself, therefore, ureterocystoanastomosis (artificial connection of the ureter with the bladder) according to Politano-Leadbetter is used.

Surgical methods of treatment are accompanied by the use of uroantiseptic and etiotropic antibiotic therapy.

For the treatment of pyelonephritis, drugs of the fluoroquinolone group are often used.

In case of duplication of the ureter and in case of atrophy of part of the parenchyma of the kidney, the affected part is removed (resection), and in case of complete atrophy of the kidney, it is removed.

Prevention

Prevention of the development of complications includes:

• timely treatment for difficult urination;
• treatment of bladder diseases with antibacterial drugs;
• following a diet that includes limited intake of salt, protein and fatty foods.

Abnormal development of the ureters is a consequence of congenital disorders in the structure or functionality of the organ that occurred during fetal development. The anatomical structure in the form of a hollow tube allows healthy ureters to efficiently drain urine from the pelvicalyceal system directly to the bladder, while organ anomalies can create serious obstructions in the outflow path. As a result of such violations, renal dysfunction develops, requiring mandatory observation by a doctor and appropriate treatment.

Symptoms of ureteral anomalies

A number of signs that can manifest themselves in varying degrees of intensity help to suspect an abnormal development of the ureters in a patient. The main one is pain syndrome, localized in the lower back and having a permanent aching character. In addition, the pathology may be accompanied by the following symptoms:

• hematuria;
• swelling of the face and body;
• arterial hypertension;
• change in the structure of urine (turbidity, foam, darkening);
• biphasic urination, which occurs due to the expansion of the lumen of the urinary tract.

Also, the patient may be disturbed by general manifestations of increasing intoxication, such as headache, fever, thirst, chills.

Varieties of anomalies of the ureters

Scientific medical classification identifies several types of pathology, depending on its localization and impact on functionality. It is customary to distinguish the following types of abnormal development:

Quantitative:

• absence or aplasia of the organ on one side or the other;
• unilateral doubling or tripling of the ureter.

Structural:

• stenosis or narrowing of the lumen;
• underdevelopment or hypoplasia of the ureteral tube;
• dysplasia of the walls of the organ, leading to a violation of adequate peristalsis;
• the presence of pathological connective tissue valves in the lumen of the tube;
• parietal diverticula;
• an enlarged ureter (megaureter);
• spherical deformity of the mouth of the organ, also known as ureterocele.

Anomalies of the structure and shape:

• ring-shaped;
• twisted like a corkscrew.

By location:

• retrocaval - annular coverage of the inferior vena cava;
• retroileal - behind the iliac vein or branches of the inferior vena cava;
• malposition of the outlet of the ureteral tube, also called ectopia of the mouth.

Causes of the development of ureteral anomalies

Because the this pathology is congenital in nature, it is necessary to dwell in detail on the provoking factors that occur during gestation future mother. These include the following preconditions:

• genetic developmental errors, as a result of which the normal formation of certain organs and systems is disrupted;
• infectious diseases transferred by a pregnant woman (syphilis, rubella), which have a high risk of congenital anomalies;
• use by expectant mother narcotic drugs or alcoholic beverages;
• the impact on the body of a pregnant woman of various occupational hazards, as well as dangerous external factors (radiation, high temperature conditions).

Diagnostic methods

The final diagnosis is made on the basis of a comprehensive clinical examination, including an objective examination of the patient, analysis of his complaints, as well as various laboratory and instrumental methods. When questioned, the doctor pays attention to the presence and duration of the appearance pain syndrome, its nature and frequency. The connection of pain with arterial hypertension, fever and manifestations of intoxication is also important.

In the anamnesis of life, diseases previously suffered by a person, including those that developed in childhood and adolescence, are necessarily analyzed. In addition, the doctor may need information about the presence of chronic pathologies in the patient and his immediate family in order to correctly assess the risk and likelihood of hereditary factors.

During the examination, certain information can be given by pain when tapping in the lumbar region and palpation of the kidneys. As you know, normally they are not palpable through the abdominal wall, while with an increase in size due to poor urine outflow, they can become noticeable on palpation. Also, a mandatory examination is the measurement of pressure, the persistent excess of which is higher than the value of 140/90 mm Hg. Art. indicates the presence of hypertension.

Of the laboratory and instrumental methods used in clinical practice, the following should be noted:

• general analysis urine - allows you to recognize the presence of inflammation in the urinary system (the presence of blood particles, salts, leukocyturia, inclusions of protein molecules, bacterial infection);
• complete blood count - assesses the state of the immune defense of the body as a whole and the presence of inflammatory processes in it, which are signaled by an increase in the number of leukocytes and an increase in ESR;
• ultrasound - allows you to find out the size of the kidneys, the features of their location and internal structure, the presence of volumetric processes (cysts, tumors, stones), the functionality of the pyelocaliceal system;
• excretory urography - a method consisting in the introduction of a contrast agent into venous system for information x-rays, clearly demonstrating the presence or absence of certain anomalies;
• retrograde urethrography - consists in the introduction of a special contrast directly into the cavity of the ureter through a catheter passed through the urethra and bladder; helps in determining the type of anomaly and the degree of expansion of the lumen;
• antegrade urethrography is another method associated with the introduction of a contrast agent, which enters the ureter by renal puncture or through a special tube installed in the lumbar region - a nephrostomy;
• MR tomography is a highly informative technique that allows you to obtain a series of sequential images in the area of ​​​​the ureter, which give a clear picture of certain developmental defects, their location, size, presence pathological processes and inclusions;
• multislice CT - a tomographic study that allows you to get step-by-step pictures of the area under study and identify ureteral anomalies, their size, position, the presence of cysts, stones, etc .;
• nephroscintigraphy is an invasive technique that allows you to assess the existing violations of the excretory function of the kidneys by introducing a special drug.

Treatment Methods

The choice of treatment tactics depends on the type of pathology and its impact on the work of the entire urinary system. In cases where the patient's condition allows you to do without surgery, the doctor prescribes conservative therapy:

• courses of antibacterial drugs to suppress the activity of pathological microflora;
• effective treatment of concomitant arterial hypertension;
• relief of symptoms of intoxication;
• vitamin and mineral preparations that compensate for the lack of certain trace elements and increase the body's resistance and stability;
• diet therapy, limiting the intake of salt, fatty and spicy foods, animal protein; recommended foods - vegetables, fruits, cereals, greens.

In those clinical cases where conservative therapy turns out to be ineffective, resort to surgical methods treatment:

• Installation of a nephrostomy consists in introducing a special tube into the kidney from the back, through which urine will be transported. The operation is performed under X-ray or ultrasound control.
• The operation of plastics of the pelvis-ureteral area, during which the expansion of the stenotic ureter is performed at the place of its attachment to the renal pelvis.
• The operation of plastics of different parts of the ureter in case of their narrowing or the presence of other pathological changes.
• Stenting - is carried out by introducing a thin plastic tube into the lumen of the ureter through the urethra and bladder.
• Transurethral excision of the ureterocele - the intervention is performed through the cavity of the bladder using a special instrument equipped with a mini video camera.
• Surgery to replace the ureter with intestinal tissue.
• Neoureterocystoanastomosis - consists in the surgical formation of a new ureteral orifice in cases where there is its congenital ectopia or a ureterocele has formed that bulges into the bladder cavity.

Possible complications and their prevention

Possible consequences of certain anomalies of the ureter may be the following pathological conditions:

• pyelonephritis of acute or chronic course, due to the development of bacterial microflora;
• hydronephrosis with expansion of CHLS;
• the formation of urolithic pathology;
• atrophy renal parenchyma, gradually leading to its dysfunction;
• symptomatic hypertension;
• formation of chronic kidney failure.

Of the preventive measures, it is recommended that certain dietary restrictions be observed, which reduce the burden on the urinary system. To increase resistance to infections, the doctor prescribes vitamin preparations, which include calcium. In order to prevent the progression of arterial hypertension, it is necessary to take antihypertensive drugs, and in the event of infectious complications, courses of antibiotic therapy. Equally important is also a rational regime of work and rest and complexes of special therapeutic exercises.

Megaureter

Megaureter is a congenital enlargement of the lumen of the ureter with dilatation of its walls and expansion of the collecting system of the kidney, provoking hydronephrosis.

Synonyms - hydroureter, megaloureter, ureterohydronephrosis.

Megaureter code for microbial 10 N 13.4. - congenital pathology, occurs more often in boys, more often left-sided, bilateral occurs in 20% of cases. This is the most common pathology of the obstructive ureter.

In such a pathology as a megaureter, the causes of occurrence are the effect of teratogenic factors on the fetus during pregnancy. Malformation of the urethra consists in persistent anatomical narrowing of the lower ureter, compensatory expansion of the lumen of the superior part of the ureter with hypotrophy of muscle fibers.

The megaureter code for the fetus is different Q 62.2. This is due to the peculiarities of prenatal diagnosis. In the context of the development of medicine and the diagnosis of diseases and malformations, it became possible to diagnose megaureter and hydronephrosis already from the 26th week of fetal development. Early diagnosis allows you to identify all deviations from the norm in the development of the fetus and make a decision on delivery in maternity ward IV level of accreditation for providing specialized care to a newborn with a developmental defect already in the first hours of life.

There is no single classification of megaureter. Urologists distinguish two main types of megaureter: refluxing and non-refluxing. There are also left-sided, right-sided and bilateral megaureter.

Refluxing megaureter (according to microbial 10 N 13.7) is caused by the throwing of urine from the bladder back into the ureter. This mechanism only worsens the condition of the elastic skeleton of the ureter and forms hypertrophy of individual directions of muscle fibers, violating normal mechanism muscle peristalsis.

Non-refluxing megaureter is caused only by stenosis of the lower ureter. Among patients with this type of megaureter, about a third of the megaureter disappears on its own due to the “ripening” of the urinary system during the first years of life.

Obstructive megaureter (a forum on urology discussed this topic) in newborns is diagnosed on the basis of prenatal diagnostic data.

Depending on the degree of stenosis of the ureter and the degree of deformation of its frame, clinical manifestations can be from the first months of life, and can be detected already in adolescence or when an infection in the urinary tract is attached.

Also, additional valves, membranes, polyps in its lumen can provoke the expansion of the ureter.

Clinically, malformations of the urinary system (megaureter in a newborn in particular) do not manifest themselves in any way until the moment of infection or until the development of renal failure. These are the two extreme manifestations of the megaureter.

When an infection joins, there will be a persistent increase in temperature above 380C, pain in the lumbar region of the back, pain in the lower abdomen on the side of the lesion, the appearance of impurities in the urine - a whitish sediment in cloudy urine or the appearance of pus, blood in the urine.

Very often, a megaureter in children (a forum of urologists also writes about this) is diagnosed against the background of an acute pyelonephritis clinic. In the advanced stages, the kidney is determined by palpation in the abdomen as a tumor - this is a direct evidence of the development of hydronephrosis.

Laboratory examination of an obstructive megaureter (the forum contains full list analyzes) according to the following criteria:

• Determination of the level of creatinine (in newborns, it is determined from the 6th day)
• Determination of the level of bicarbonates or chlorides
• Urinalysis for sterility
• Clarification of the concentration function of the kidneys

Instrumentally, the diagnosis of megaureter is confirmed:

• Ultrasound of the kidneys and urinary tract
• Excretory urography
• CT of the retroperitoneal organs with contrast
• Cystoureterography
• pyeloscopy

Treatment of the megaureter of the ureter begins with drug therapy against the background of periodic monitoring of the state of the ureter and kidneys in dynamics.

Initially, regular antibiotic prophylaxis of exacerbations of pyelonephritis is carried out. The range of antibacterial drugs for use is wide, it affects penicillins, cephalosporins, nitrofurans.

With frequent pyelonephritis, antibiotic therapy can have a short-term effect. Here, drainage of the megaureter will already be needed, and this is surgery.

Drainage is also carried out in order to unload the ureter in children and, often, after drainage, the non-refluxing megaureter returns to the functional norm.

With a gross violation of urodynamics in newborns, the operation is postponed until 3-5 months of age. This is due to the fact that the newborn baby has too low body weight to undergo surgery without complications and risk to life. While waiting, doctors monitor the condition of the kidneys and urodynamics.

It is important for parents to accept the fact that the only chance for full life their children with a diagnosis of "megaureter" - surgery; how long the rehabilitation period lasts is no longer so important. It is important for severe malformations, when the kidney is affected at the time of the birth of the baby, to correct the ureter as soon as possible and unload the kidney.

There are many doubts about the curability of megaureter without consequences and complications. Mom-members of the forum are concerned about the question “who cured the megaureter code microbial N 13.4?” The answer to this question lies in the characteristics of each individual case. If at the time of the start of treatment the child already has chronic pyelonephritis, hydronephrosis, this pathology will remain with him forever. It can go into a stable remission stage with the right approach.

All children with obstructive pathologies of the urinary system, even after surgical treatment, are recommended to undergo regular examinations by a urologist, follow all infection prevention measures or prevent recurrences of infections.

General concept of urethrocele

Ureterocele (ICD-10: N28.8) is a pathology of the ureter that occurs in both men and women and is defined as an abnormal, cystic dilatation of the ureter bulging into the cavity of the bladder. In urological practice, it occurs with a frequency of about 4 people per 10,000 population, while according to statistics, it is found more often in females.

A ureterocele is a cyst inside the bladder. Cystic enlargement, bulging of the bladder - all this refers to the ureterocele. Basically, the female gender is exposed to the ureterocele, but boys should not be excluded, since they can also identify a cyst in themselves. Symptoms are detected in childhood, but it can still be detected as an adult. Accompany ureterocele - doubling of the ureter, hematuria, as well as back pain and dysuric disorders. The location of the cyst can be absolutely anything, the ureterocele on the right is as common as on the left. In girls it is the ureter or vestibule of the vagina, and in boys it is the prostatic urethra.

Ureterocele in women

As already mentioned, women are more prone to ureterocele than men. Symptoms can vary, for example,

• fever;
• pus in the urine;
• pain in the lower back or in the bladder area.

In general, the process is accompanied by constant pain defects, so treatment should begin as early as possible.

On forums that discuss this problem, you can see the following heading "ureterocele in women surgery." The bottom line is that surgery for ureterocele is necessary procedure especially when the protrusion is too large. If the situation is extremely difficult, it is possible to remove the edge of the kidney so that the disease does not progress.

Where can I find information about surgery in children?

The ureterocele is serious illness, which is most progressive in children. Of course, if you go to the hospital on time, you can recover quickly, but if you start it, then you definitely can’t do without an operation.

In second place after women is the following query "ureterocele operation in children forum". On the forums, you can really learn a lot from people who have already gone through it. You can learn about pathologies and complications, as well as when a simple removal is required, and when a serious transplant is required.

How is a bladder ureterocele removed?

To transfer the removal of the ureterocele of the bladder is not difficult, it is difficult to endure constant pain. The operation itself consists of the following steps:

• antimicrobial therapy;
• Nephrectomy (when the kidney is not functioning);
• Endoscopic dissection of the ureterocele (when the kidney is functioning).

Each of the processes takes a certain time, as a result of the second, which can be divided into nephrectomy and endoscopic dissection, the obstruction of the ureter is removed or the ureterocele of the ureter is excised.

Ureterocele ICD-10

Ureterocele (ICD code - 10 - N.28.8). This code is subdivided, shows a more accurate and specific disease, but if we talk in general about a cyst inside the bladder, then the ureterocele μb 10 N28.8 is exactly the code by which you can find the disease and learn more about it.

There are also special units for special cases, for example, for pregnant women, as well as children, because no one is immune from illness.

Treatment of ureterocele in men, consequences

The male gender, although less prone to ureterocele, there are cases when a man has a cyst in the bladder. How to treat a ureterocele, and what consequences can arise in case of a late visit to the clinic?

The treatment of ureterocele in men and the consequences are important aspects, but before understanding them, you need to understand the causes.

• An anomaly that is congenital (lack of muscle fibers);
• Blockage of the mouth of the ureter (the main cause is kidney stones, which many people have).

In the ureter, pressure begins to rise, and its walls begin to expand, the expansion is able to exfoliate the walls of the bladder, and then form a new cavity. This cavity is filled with urine and a ureterocele is formed, which is constantly increasing.

How to get rid of ureterocele?

• First of all, start with a diagnosis. It is necessary to pass urine for analysis, conduct an ultrasound of the bladder, check the kidneys. Get an x-ray to know for sure what's going on inside you;
• Preparation for the operation, since apart from removal, there are practically no options for solving the problem. No need to look for ways to treat at home, they simply do not exist. The operation must take place in a hospital with all conditions, with disinfection carried out in advance;
• Endoscopic removal is used when the size of the protrusion is small. Anti-reflux surgery is the type of treatment that is required for severe bulging;
• The operation is combined with antibiotic therapy, therefore, do not neglect the additional medicines prescribed by the doctor;
• Drugs that belong to the group of fluoroquinols and are drugs for the treatment of this problem.

A ureterocele can lead to the following:

• hydronephrosis;
• bleeding;
• stones in the kidneys;
• cystitis;
• kidney failure;
• pyelonephritis;
• kidney atrophy.

Of course, all this can be avoided, it is enough to follow the rules of prevention that will help you get to know your health better and maintain it on highest level. Prevention is as follows:

• Periodic examination by a urologist;
• Compliance with personal hygiene;
• Treatment of diseases on time, as a variety of factors can affect the bladder.

Ureterocele Requires Major Surgery I Would Like to Learn About more themes who will soon have such an operation. Reviews about ureterocele are left on thematic forums, so if you are interested, you can always find a forum and read stories about ureterocele, so that, based on the experience of others, do not make mistakes and properly prepare for the operation.

Services table

A ureterocele in a child can be either a congenital pathology or an acquired disease. Primary ureterocele is due to the fact that the tissue of the walls of the ureter during formation genitourinary system the embryo is not completely resorbed, and a seal is formed, which reduces the diameter of the ureter. The narrow passage of the ureter into the bladder increases the pressure of urine and prevents its free outflow.

A secondary manifestation of an ureterocele is a blockage of the mouth of the ureter due to the formation of a stone in the kidney, which, due to urolithiasis enters the ureter.

Regardless of the cause of the appearance, the ureterocele disrupts the normal outflow of urine through the mouth of the ureter in the bladder and leads to further complications of the child's urinary system, up to kidney failure.

Symptoms

Sometimes a ureterocele in children may not show any symptoms until inflammation of the kidney (pyelonephritis) develops. In this case, the symptoms of the disease will be pain in the lumbar region, cloudy urine, elevated temperature body.

When the ureterocele overlaps the mouth of the ureter, there will be problems with urination. It can also lead to frequent but small urination.

When the ureterocele descends into the urethra, the valve that regulates the outflow of urine is disturbed, which provokes urinary incontinence (enuresis).

These symptoms can be correlated with three stages of ureterocele development:

• the first stage involves a slight increase in the ureter, which does not affect kidney function;
• the second stage is characterized by the expansion of the cavity of the kidney and ureter due to the constantly accumulating urine and can lead to the occurrence of ureterohydronephrosis;
• the third stage of development of the ureterocele, in addition to the complications of the second stage, leads to dysfunction of the bladder (incontinence).

Diagnosis of ureterocele in a child

Data for the diagnosis of ureterocele are usually taken from the results of a clinical analysis of urine and ultrasound of the kidneys. It is not uncommon for an asymptomatic ureterocele to early stages is detected during the diagnosis of other diseases affecting the urinary system.

A specialized method for diagnosing a ureterocele in a child is cystourethrography. This is a type of study in which the bladder is filled with a special drug that contrasts on x-rays. An X-ray of the bladder and urethra shows abnormalities in their physiological structure and the presence of a ureterocele.

Conducting excretory urography gives an idea of ​​the expansion of the pyelocaliceal system, which is often caused by a ureterocele at the second stage of development. Also, this method helps to identify violations in the filling of the bladder.

Complications

Violation of the outflow of urine from the ureter to the bladder can lead to deformation of the organs of the urinary system. because of high blood pressure and tissue stretching, the pelvicalyceal system increases, the ureteral canals can be clamped.

Stagnation of urine due to its improper outflow can provoke the development of urolithiasis and the formation of kidney stones, as well as various inflammatory processes in the kidneys or bladder (for example, pyelonephritis of varying severity).

After the surgical treatment with resection and relocation of the ureter, the formation of vesicoureteral reflux is possible, in which the natural outflow of urine is disturbed.

In the advanced stage of the ureterocele, complete dysfunction and atrophy of the kidney is possible.

Treatment

What can you do

There is no way to cure a ureterocele at home; surgical intervention by doctors is always required for treatment. But to alleviate the condition of the child, it is necessary to adhere to simple rules maintaining immunity and a balanced diet. Exclusion from the diet of spicy, salty, fried foods and high-protein foods will reduce the burden on the kidneys and urinary system. And the healthy immunity of the child will help him to undergo the operation with minimal consequences and quickly restore the body's strength after it.

What does a doctor do

With a small size of the ureterocele at the first stage of the disease and the absence of disorders of the neuromuscular tissues, the operation consists in dissecting the very mouth of the ureter. This helps to return the correct outflow of urine, reduce pressure on the bladder and restore the entire urinary system.

Often, as a treatment, the creation of a new mouth is used, to which the ureter is re-sutured. This avoids complications and recurrences of the disease, since modern methods of treatment allow artificially creating mechanisms to protect the bladder from re-deformation.

If the ureterocele has reached the stage at which the ureter has doubled and scar tissue in the kidney has begun, then the treatment will be partial resection (removal) of the kidney and the affected part of the ureter.

In the case when the kidney completely loses its function, it is necessary to remove it or even transplant it. Such an operation is prescribed only after a thorough examination and when the child's body is fully prepared for this load.

Prevention

For the prevention of not only ureterocele, but also other diseases of the urinary system, one should mainly pay attention to general state organism and immunity of the child. Proper nutrition, regular physical exercises, timely preventive examinations by specialists will allow, if not to avoid many diseases, then at least to identify them in the early stages and start treatment in time.

If the child complains of difficulty urinating, you should immediately contact a pediatrician who will be able to conduct an initial examination of the patient and, if necessary, give a referral to visit a pediatric urologist.

Canned foods should not be included in the baby's diet. a large number of spices and salts, fatty and fried foods, but the drinking regime must be observed. This will minimize the burden on the kidneys, reduce the pressure of urine in the bladder and avoid the development of the disease.

You will also learn how untimely treatment of ureterocele disease in children can be dangerous, and why it is so important to avoid the consequences. All about how to prevent ureterocele in children and prevent complications.

And caring parents will find on the pages of the service full information about the symptoms of ureterocele disease in children. How do the signs of the disease in children at 1.2 and 3 years old differ from the manifestations of the disease in children at 4, 5, 6 and 7 years old? What is the best way to treat ureterocele disease in children?

Take care of the health of your loved ones and be in good shape!

Ureterocele is a pathology associated with the expansion of the distal ureter, in which the occurrence of cystic nodes and their prolapse into the bladder cavity is observed. The disease is congenital, but there are cases of acquired disease. This anomaly of the urinary system occurs in both men and boys. Therefore, it is important to know about the causes, symptoms, and treatments for ureterocele in men and children.

Causes and types of disease

Causes of ureterocele include:

• intrauterine disorders in the development of the distal (lower) ureter of the fetus, accompanied by a lack of muscle fibers of the walls of the bladder and pathological narrowing of the mouth of the ureter;
• the formation of stone deposits in the kidneys and their movement into the ureter, which leads to blockage of the mouth and expansion of the tube.

When the outlet narrows or becomes blocked, the lower part of the ureter expands and its walls inevitably stretch. Cavities resembling cysts are formed, which are filled with urine. Sometimes their contents may be watery or purulent. Outside, they are formed from the mucous membrane of the bladder, and inside - from the mucous membrane of the ureter. In the future, these cystic formations can fall into the bladder and even the urethra.
With the accumulation of urine, the ureterocele increases in size, and after emptying the bladder decreases.
There are three types of illness:

• Ectopic. It is characterized by opening into the diverticulum of the bladder or urethra.
• Prolapsing. This is a type in which pathological nodes fall into the urethra.
• Simple. Cystic formations are located in the cavity of the ureter. It is divided into one-sided and two-sided.

The first two types are congenital, in adults the simple variety is more common.
If this anomaly is not treated, serious complications are possible, up to kidney failure. Therefore, it is important to start therapy on time. When the size of the cyst is small and it does not affect the organs of the urinary system, treatment is not carried out.

Ureterocele in men

In adults, in most cases, a simple form of the disease occurs, in which the hernial protrusion is located in the bladder. There is a bilateral lesion. Often the disease is accompanied by the presence of kidney stones. Usually the disease does not manifest itself until the development infectious diseases kidneys.
Symptoms that occur in men:

• Aching pain in the lumbar region, feeling of fullness.
• Fever.
• Pain when urinating.
• Urinary incontinence or difficulty urinating.
• Peculiar smell of urine.
• Pyuria (when pus is found in the urine, it becomes cloudy).
• Hematuria (the presence of blood in the urine, the color at the same time resembles meat slops).
• Frequent infectious diseases of the genitourinary system.

If these signs appear, you should seek the advice of a specialist - a therapist or urologist.

Features of the course of ureterocele in children

Pathology of the ureter is not very common, in one in five hundred newborns. In 15% of cases, the disease is bilateral. Girls get sick three times more often than boys. During examination, the fetus is diagnosed with hydronephrosis. It may be due to ureterocele, which is diagnosed after the birth of a child.
Children have three degrees of development of the disease:

• Grade 1: A slight enlargement of the lower ureter that does not affect the functioning of the upper urinary tract.
• Grade 2: a significant increase in the intravesical section, in which the outflow of urine from the kidney is disturbed, and hydronephrosis occurs.
• Grade 3: Accompanied by hydronephrosis of the kidney and serious disturbances in the functioning of the bladder.

Ureterocele in children is divided into ectopic and simple. Ectopic is characterized by an unusual location of the mouth of the ureter. It may be lower, flow into neighboring organs. Often the ectopic variety is combined with a doubled ureter and pelvis. Paired ureters are intertwined and exit from different lobes of the kidney. It is this type that is diagnosed in babies. early age. With a simple course, the mouth of the ureter is located normally.
Symptomatic manifestations of the disease depend on the size of the cystic formations, their location. For small sizes clinical symptoms not visible. Children often experience discomfort when urinating. Symptoms in a baby include difficulty urinating, pain that does not have a specific location. Palpation reveals hydronephrotic disorders of the kidney. There are cases of prolapse and infringement of the ureterocele in the genital slit.
Older children develop aching, dull pain, which are localized in the lumbar region on the side where there is a pathology. When a child complains of difficulty urinating and pain, it is worth contacting a pediatric urologist or pediatrician to begin treatment.

Diagnosis of ureterocele

Ureterocele in children and adults is detected using:

• cystourethrography;
• ureteroscopy.

Ultrasound procedure

In addition, the doctor may prescribe a general blood and urine test.
During an ultrasound examination, a pear-shaped or round pathological formation of the bladder can be detected. However, the interpretation of the obtained results is sometimes erroneous. If the ureterocele is large, then with an empty bladder, ultrasound shows that it is full. And also, if the formation has decreased in size, then with a full bladder it cannot be detected. Only the expansion of the intravesical ureter is diagnosed. Therefore, there is a possibility that the diagnosis is incorrect.
With cystourethrography, a contrast agent is injected into the bladder using a catheter, and then an x-ray is taken. On x-ray, the abnormal mass may be found in the center of the bladder, on the sides, on the neck, or on the proximal urethra. Along the way, vesicoureteral reflux is detected when the valve separating the ureter and bladder is absent or underdeveloped. Reflux ureterocele is rare. More often it is determined in the adjacent ureter with doubling of the urinary tract.
Ureteroscopy is another popular method of examination for diseases of the urinary system. Children are carried out at general anesthesia. The essence of the method is that through a special optical instrument - a ureteroscope, you can see the mucous membranes, detect pathological formations, and take the material for analysis. With the help of a ureteroscope, various therapeutic manipulations are carried out, including dissection of the ureterocele.

Treatment of ureterocele

Ureterocele is not a disease that goes away without treatment. And if the patient, when signs are detected, thinking that the disease will pass on its own, delays the moment of visiting the doctor, this can provoke complications.
Treatment depends on the age of the patient, the presence of complications, anamnesis. There is no conservative treatment. Congestion in the bladder and ureters suggests the presence of infectious diseases. Therefore, with ureterocele, before proceeding with surgical treatment, antibacterial drugs are prescribed.

For decreasing pain the patient can apply suppositories. For example, St. Diklovit. They are inserted into the rectum after a bowel movement or cleansing enema. St. Diklovit are non-steroidal anti-inflammatory drugs that have an analgesic effect. For the treatment of inflammatory processes before surgical intervention St. Diclovit is used one or two times a day. The course of treatment with suppositories is prescribed by a doctor.
Contraindications to the use of St. Diclovit are pregnancy, children under 6 years of age, disorders in the hematopoietic system, stomach ulcers and duodenum. After surgery with St. Diclovit can also be anesthetized.

Treatment of ureterocele is carried out using minimally invasive techniques or abdominal operations. The type of tactics chosen depends on the characteristics of the course of the disease, the size of the cyst, its location, and the effect on other organs of the urinary system. Main treatment options:

• Open surgery to remove the ureterocele. At the same time, reanamostosis is done. That is, the ureter is implanted in the right place on the bladder.
• Nephrectomy. A complete or upper lobe is performed. To do this, make an incision in the intercostal space or use a laparoscope. This method of treatment is preferable for large lesions. It consists in removing the whole kidney or part of it that is not functioning. Due to hydronephrotic disorders, irreversible changes in the functioning of the organ occur. Removing the affected segment allows you to save the healthy part. In this case, excision of the ureterocele is performed. Top part The ureter is reimplanted (transplanted) into a functioning pelvis. The lower part is given a normal location in the bladder.
• transurethral intervention. Can be used in patients of any age. Performed on a small scale cystic formation, which is localized in the cavity of the bladder. With the help of special instruments - a cystoscope or an endoscope, the doctor penetrates through the urethra into the bladder. Then, depending on the chosen tactics, it performs drainage (puncture) of the cyst or its complete dissection and removal. The procedure takes up to half an hour. The advantage is low trauma, short recovery time, no sutures.

After the operation, the patient is under observation in the hospital. For full recovery need to be at least 2 weeks. If necessary, pain medications and antibiotics are used. Before discharge, a control ultrasound is done for the functioning of the ureter and renal pelvis.

After six months, you need to re-examine. After a minimally invasive intervention, the work of the urinary system is restored in almost 100%. However, there are times when it is unavoidable surgical operation. For example, when vesicoureteral reflux develops.

Rehabilitation after surgery

After discharge from the hospital, adults should follow a diet. It is necessary to give up spicy and fatty foods; reduce protein and salt intake. Physical activity should increase gradually.
If the child undergoing surgery is on breastfeeding, despite the circumstances, it is important for mom to save milk. Breast milk will help the child recover faster after an illness, as it contains useful substances responsible for the formation of immunity. Mom's menu will also have to make some adjustments.
If the child is older, you should organize good nutrition and proper drinking regimen for him.
With timely intervention, the prognosis for operated patients is quite favorable.

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A ureterocele is a congenital anomaly that affects the kidneys, bladder, and ureters.

The wall of the ureter, which passes through the wall of the bladder, protrudes like a hernia, which leads to a violation of the outflow of urine - it begins to accumulate in the ureter.

What are the symptoms of a ureterocele, how is it treated, and what complications are possible?

Classification of violation

Pathologies of the genitourinary system are quite common.

Ureterocele is diagnosed in 2-2.5% of patients who come for a consultation with a urologist.

Among newborn children, ureterocele in girls occurs 2 times more often than in boys. The frequency of the disease is 1 case out of 500.

The location of the mouth of the ureter can be:

• normal;
• atypical (ectopic);
• bilateral or unilateral;
• in one of the two double ureters.

Also, the violation is intravesical and ectopic. With the intravesical type, the cyst is located inside the bladder, and with the ectopic type, it goes beyond it.

Localized in the neck of the bladder or in the urethra.

How does the disorder develop?

Disease stages:

• the expansion of the ureter is not expressed, which does not lead to transformation in the urinary tract;
• the cyst is enlarged in size and leads to the appearance of ureterohydronephrosis (expansion of the pelvicalyceal system due to a violation of the outflow of urine);
• the functions of the ureters and bladder are disturbed.

Features of the disease

Often ureterocele is diagnosed in childhood, rarely in adults. Before the advent of ultrasound, the disease was diagnosed by frequent genitourinary infections.

Violation in women

With a ureterocele in women, there is a risk of prolapse of a cystic protrusion during urination.

It is covered with dark red mucus and somewhat resembles the male genital organ in shape. It adjusts on its own and has a periodic character.

Often, an anomaly in girls is combined with a doubling of the ureters.

Violation in men

With a ureterocele in men, the cyst falls out in the prostatic region, but it is quite rare. Most often, the disease is manifested by a violation of urination and pain in the lumbar region.

Reasons for the development of the anomaly

There is a congenital and acquired disease. The exact causes of the congenital phenomenon have not been fully understood, so doctors know little about this disease.

It has been established that a newborn is born with an anomaly as a result of infections in the mother's body.

These include not only such serious infections as rubella and toxoplasmosis, but also herpes, cytomegalovirus and others, often living in human body and untreatable.

The manifestation of these infections restrains only strong immunity. Their diagnosis should be given special attention.

Other factors that lead to congenital anomalies fetus, include alcohol intake, smoking, contact with chemicals(cleaning products) and taking medications.

Alas, it is with the latter that things are difficult - a woman weakened by pregnancy needs certain groups medicines. The drugs taken must be approved by the attending physician!

Acquired ureterocele occurs due to infringement in the segment of the ureter.

Features of the clinical picture

It is very difficult to determine the disease - sometimes even experienced urologists cannot do it, since it has practically no characteristic symptoms.

The initial degree of violation does not manifest itself at all. A protrusion of the wall of the ureter can put pressure on nearby organs and tissues, causing certain symptoms.

First of all, they take a hit iliac arteries that cause intermittent claudication.

When overcoming a certain distance, a person begins to be disturbed by pain in the leg, which disappears after a couple of seconds after rest.

Patients are concerned about persistent back pain, frequent infections (,), accompanied by fever, as well as, with or having.

Urinary function is disturbed, as the volume of the bladder decreases. , in small portions. With small sizes, this symptom is the only one.

If the second ureter is blocked, then acute phase. Partial blockage of the outflow of urine from the kidney causes severe pain similar to, therefore it is urgent to call a doctor.

Diagnostic methods

If an anomaly is suspected, it is necessary to carry out the following diagnostic measures:

The only treatment is surgery

Treatment for ureterocele can only be surgical, since the formation must be removed.

Taking drugs with a diuretic effect will only eliminate the symptoms and temporarily delay the visit to the doctor.

Before surgery, it is advisable to carry out antimicrobial therapy aimed at treating genitourinary infections.

Broad-spectrum drugs are prescribed that can cope with both gram-positive and gram-negative bacteria.

The operation involves dissection of the ureter, from the remaining part of which an orifice is formed so that henceforth urine is not thrown into the ureter from the bladder.

The most applicable at present is laser dissection of the ureterocele, which belongs to minimally invasive methods.

If a non-working kidney or one of its parts is diagnosed, then in this case the organ or part of it is removed (). Simultaneously with the removal of the organ, excision of the ureterocele is performed.

This anomaly, with untimely treatment, is quite dangerous, as it leads to severe impairment of kidney function.

However, with timely therapy, the violation does not pose a threat to the life of the patient.

Even this dangerous state, as a rupture of the ureter, due to the appearance of a large ureterocele, is successfully treated with proper care.

After the operation, you can safely work and engage in physical labor. The period until complete recovery lasts about 2 weeks.

In order to prevent complications after ureterocele, a certain diet is necessary. It is important to limit the intake of salt, protein and fatty foods. Give preference to cereals, vegetables, fruits.

I prescribe medications that reduce blood pressure and antibacterial agents.