Aplazija v sečevod - Vzroki , simptomi in zdravljenje.MF .
aplasia kidney and ureter - is a congenital anomaly of the genitourinary system, which manifests complete absence of one or both ureters.It occurs one-sided and double-sided aplasia ureter.The second form of the disease is incompatible with life, so in a clinic of urologic diseases considered only unilateral aplasia of the ureter.
left to right: aplasia of the left kidney and ureter, aplasia of the right kidney and ureter with the location of the ureteral orifice left, aplasia of the left kidney with sohranieniem ureter (incomplete aplasia of the ureter)
reasons aplasia ureter
Significant causes of genitourinary anomaliesthe system is difficult to call.Scientists say that in this play the role of both internal and external factors.Among the internal factors can be identified hormonal metabolism of pregnant women related chronic diseases accompanied by anemia and hypoxia, as well as systemic connective tissue disease.
With regard to external factors, it is considered that the development of apl
almost always combined with ureter aplasia aplasia or agenesis of the kidney on the same side.In those rare cases where patients are born with normal kidney and ureter lack of it in a short period of time it will atrophy.
Symptoms aplasia ureter
Typically, aplasia of the ureter is asymptomatic.Often it is a random finding during the examination of the genitourinary system about some other diseases.
At the same time, if there is an incomplete aplasia of the ureter, in which the cavity of the bladder moves a small tank, lined with cystic epithelium, its infection can occur.The reason for this is the continuous stagnation of urine in this process.In this situation, patients begin to celebrate the pain in the lumbar region and the iliac bones, increased body temperature and urination disorders in the form of an increased urge incontinence and turbidity.
If a person has any congenital anomalies, or one of his relatives suffering from a hereditary kidney disease, it must be investigated and for the health of the genitourinary system.In addition, the above-mentioned complaints are a direct indication for the treatment of the patient to a urologist.
Diagnostics aplasia ureter
The general analysis of urine, which is carried out without exception, patients with disorders of the genitourinary system, it is possible to detect a small amount of red blood cells and white blood cells.It should be noted that such analyzes are only observed upon infection of the ureter, while at the latent current of urine is totally "quiet".
«gold standard» to verify the diagnosis of aplasia of the ureter may be considered excretory urography.The method is based on the intravenous administration of contrast followed by X-rays of the genitourinary system.In most cases, selection is marked contrast to only one point.In partial aplasia of the ureter it can be detected by a thin strip of the contrast, which shows a partial cross-ureteral.
excretory urography: aplasia ureter
Ultrasound examination, which is carried out in all patients with disorders of the small pelvis, reveals a decrease in the size or total absence of kidney on the affected side.Since ultrasound allows to visualize only parenchymal organs, ureter itself, or rather its absence, in most cases it goes unnoticed.
In some hospitals, permitting equipment and qualification of doctors performed another cystoscopy and bladder.It gives the opportunity to see the opening of the ureter, which in the case of aplasia of the latter, is completely or partially closed.
Treatment aplasia ureter
In asymptomatic patients the disease shows only periodic supervision by a urologist.In particular they do not need treatment.When infected stump of the ureter, the symptoms of which have been described above, it is recommended surgery to remove a given formation.
quick access on the side surface of the abdominal incision is performed.Blunt and sharp by fatty tissue and is passed from the surrounding tissues is allocated bladder.Located infection ureteral stump, and tied at the bottom.Further assembly is dipped into the bladder wall.For this purpose, around the stump purse string suture is applied, which creates a loop which is immersed and ureter.
the next step is to remove the remaining portion of the ureter.It is removed in the same way as in the previous case.After ligation of the ureter, the last cut off.Altered kidney, which is located deep in the soft tissue of the retroperitoneal space, do not touch it, because it threatens the removal of the risk of bleeding.
retroperitoneal drainage installed, which appear on the skin of the back surface of the abdomen.The aim of staging is to remove residual blood and inflammatory fluid.
Ends stratified operation is suturing the surgical wound and applying an aseptic bandage.In some instances, urethral catheter direction produced in order to not create pressure in the bladder.
Since indication before surgery served as a bladder infection in the postoperative period is necessary to active treatment of cystitis.For this purpose, broad-spectrum antibiotics, such as ceftriaxone or gatifloxacin, which are administered intravenously and intravesically through a previously installed a urethral catheter.
rehabilitation after illness
Any surgical intervention through the retroperitoneal space is traumatic enough, so sick the first time after the operation is necessary to comply with bed rest.On this very stage it is very important for the proper care of the operating wound for prevention of secondary infections.Daily change of aseptic dressings to prevent the accession of infection at the site of the surgical approach.
Together with other rehabilitation methods actively applied physiotherapy treatment, which is the use of magnetic therapy, darsonvalization, electrophoresis painkillers solutions and UHF.Contraindications to the use of physical therapy may be already developed infectious processes on-site surgical wound.
Feeding habits and lifestyle
Since patients with hypoplastic ureter actually live with one kidney, they need profilaktirovat her disease.Such patients not desirable to walk in wet weather, cold drinks consumed in hot weather and in contact with sick colds.The reason for this is that the angina that occurs in these patients, often produces complications in the single kidney, that ends glomerulonephritis.The disease is chronic and, if left untreated, will certainly end renal failure.
Treatment folk remedies
Those diseases that require treatment for their surgery, a priori, can not resist the folk therapy.Often such treatment, in contrast, leads to a deterioration of the general condition of the normal delay therapy.Therefore, with such a disease should immediately seek the assistance of a qualified technician, and not to tempt fate, checking on all the domain of traditional medicine.
Complications aplasia ureter
most common complication of this disease should be considered as infected altered ureter.As has been said, it appears minor back pains and urination disorders.If untreated cavity is formed purulent inflammation of the ureter, which may spread to the fatty tissue of the retroperitoneal space.In this situation, patients notice a sharp pain in the lower back, which is accompanied by a sharp increase in body temperature to febrile digits.
When bladder infection may also occur through contaminated urine cast in a single kidney, which ends with the development of pyelonephritis.As the inflammation develops in a single kidney and urinary process is not compensated for by the second, patients immediately acute renal failure develops.In the absence of adequate treatment in the intensive care department is the clinical condition of the patient is sure to end in death.
Prevention aplasia ureter
prevention of this disease in the first place, should be engaged in pregnant women.During gestation the mother of the child is not allowed to drink alcoholic beverages, drugs embryotoxic and stay in the zone of high radiation contamination.In addition, frequent stress and trauma during pregnancy may also contribute to birth defects of children with multiple, including the genitourinary system.
If at birth the child has the defect has been diagnosed, it needs to undergo periodic inspection at the urologist.This is done in order to control the functional state of the kidneys, and the time to determine the indications for surgical intervention.
forecast aplasia ureter
Forecast for life, in most cases, favorable.Lethal results observed in the rare cases when there is an inflammation of a solitary kidney.
prognosis for recovery unfavorable.Despite the fact that, technically, to reconstruct the modified ureter, this procedure may not make any sense as to restore altered kidney transplant is only possible through that is also unreasonable in normal functional condition of the second body.
forecast for adverse health.All patients with this pathology are the third group of disability, allowing them to deal only with those activities that do not require physical exertion.Such patients are on life-long pensions and do not require periodic medical perekomissii *.
* According to the RF Government Decree of 20 February 2006 № 95 "On the procedure and conditions for the recognition of disabled persons»
Ed.urologist, sexologist-andrologist Plotnikov AN