Stenosis of the ureter - Causes, Symptoms and Treatment .MF .
ureteral stenosis - is a congenital or acquired pathology that is characterized by complete or incomplete narrowing of the lumen of the ureter and the violation of evacuation of urine.
Causes of ureteral stenosis
In its origin stenosis of the ureter is divided into congenital and acquired.If you find out the exact causes that lead to congenital stenosis is not possible, the etiology of acquired stenosis is known.
Most often, the development of ureteral stenosis contributes to this body injury.Moreover, it may be either by external injury, and on intrinsic factor.Among the external factors, the most frequently stenosis develop on the background of retroperitoneal hematoma, which occurs due to blunt impact to the waist.Gunshot, cutlery and other open injuries of the ureter are much rarer, although they also recovered as the cause of acquired stenosis of the ureter.
causes of internal trauma, which promotes the development of stenosis of the ureter, are stones that form in the kidneys.At the same time
Symptoms of ureteral stenosis
Symptoms of stenosis caused by disturbance of passage of urine in the bladder and delay it in the cavity of the renal pelvis.This condition is accompanied by stretching and tensioning kidney renal capsule that leads to the development of acute pain.Patients complain of pain in the lumbar region, which at first are cramping, and later permanent.Can irradiation of pain in the vulva.Most often there is a stenosis of one of the ureters, so pain is usually localized to one side.
If the urine from the kidneys are not evacuated in time, it leads to the destruction of nephrons and hit it in the blood.Patients immediately develops a reaction temperature, marked yellowness of the skin, nausea, vomiting and sharp smell of urine out of his mouth.The clinic is a condition referred to as uremia.Without adequate and timely treatment of patients it ends in death.
Thus, if a patient says similar clinical symptoms or had a history of data are available for blunt abdominal trauma, it requires immediate consultation of the urologist, to avoid the development of acute ureteral stenosis with uremia.
diagnosis of ureteral stenosis
Urinalysis can give results about the presence in urine of a small amount of blood, which is the result not of the stenosis, and injury, preceding it.Thus, this method of diagnosis is completely uninformative for diagnosis of ureteral stenosis.
«gold standard" in this pathology verification can be considered as excretory urography - research, the essence of which lies in the X-ray image of the genitourinary system, after intravenous administration of contrast.As a rule, the results of the study point to "break" the contrast is just at the level of the stenosis.In this case, the upper part of the ureter with kidney compensatory expand and they accumulate a large amount of urine.
excretory urography: ureteral stenosis
Ultrasound examination makes it possible to identify on the affected side dramatically altered and enlarged kidneys.At the same time, and the place itself ureter stenosis can not visualize.
additional modern method of verification of the diagnosis can be considered a cystoscopy.It is the examination of the bladder mucosa using a special optical device.After local anesthesia of the urethra metal tube is inserted through it, which is the cystoscope.The doctor, watching through the peephole cystoscope can thoroughly inspect the mucous membrane of the bladder.To verify ureteral stenosis, cystoscopy should be supplemented with intravenous administration of indigo carmine.The substance is filtered by the kidneys and a few minutes later he begins to flow into the bladder via the ureters holes.Naturally, when one of them stenosis, indigo allocated only one hole, which indicates the presence of disease.
Treatment of ureteral stenosis
therapy of this disease in the first place, should be directed to the evacuation of urine from the bladder.This can be done several, completely different, ways.
most modern method is considered ureteric stenting, which, because of its practicality and minimally invasive, are widely spread in Europe and the United States.Using the same cystoscope, which performs diagnostic inspection of the cavity of the bladder, made staging a thin tube into the cavity of the renal pelvis through the ureter opening nonfunctioning.If the doctor fails to pass the barrier, then the cystic end of the tube starts to separate urine.Typically, it has a more concentrated color and may contain an admixture of blood.
fail to exercise this method, you can use percutaneous kidney drainage.For this is performed under local anesthesia of the skin puncture in the lumbar region.Foreign experts recommend to perform this procedure under the control of ultrasound, but in the absence of the latter, you can make a start and by anatomical landmarks.Once the needle is wound in pelvic cavity, it is held by a rubber catheter which is fixed on the skin for a constant flow of urine.
Well, the latter method is a urine evacuation emergency surgery, which is performed only in the presence of all necessary equipment and appropriate training of doctors.The aim of the operation is not only the evacuation of urine, but also the elimination of the immediate causes of violations of its outflow.Place ureteral stenosis usually removed, and then the two ends of crosslinking body.If the stenosis is greater slowness and execute it impossible to plastics own tissues, artificial implants are used to restore the flow of urine.Also known techniques, when the end of the ureter extending from the kidney, is sewn in the same body with the other hand.In this case the outflow of urine from both kidneys occurs in a ureter.
operation to remove ureteral stenosis
Any of the above process ends imposition nephrostomy - a special tube that appears on the skin of the waist and which the flow of urine.This is done so that in the first days after the operation did not load ureteral anastomosis, which may just burst.
Any type of treatment is complemented by mandatory appointment of antibacterial therapy.This is done in order to prevent secondary infection joining.After the operations most commonly used antibiotics in the urogenital organs and cephalosporin series fluoroquinolone in particular or ofloxacin cefuroxime.They have a good effect against any pathogenic flora.
rehabilitation after illness
rehabilitation of such patients, mostly associated with nephrostomy.If patients have a few months to go to the tube through which urine is released, it gives moral and physical discomfort.The first patients should be taught to properly care for a stoma, in order to avoid postoperative wound infection occurred.It is recommended to change the dressing and place handle lock tube antiseptic solutions based on iodine or alcohol on a daily basis.
addition, when sluggish wound healing is possible to use physical therapy in the form of magnetic therapy, darsonvalization or UHF.you need to spend about ten treatments, lasting 20-30 minutes to improve regeneration ability.
Feeding habits and lifestyle
Patients assigned table for the seventh Pevzner, which restricts the use of alcohol, coffee, strong tea, pepper, salt, sour, fried and smoked products.In addition, patients are prohibited to consume plenty of water and juices, as well as fruit, contributing to an increase in urine output.The latter include watermelon or strawberries.Water treatment in these patients should be monitored, so it is recommended daily to record data on the number of fluid intake and urine output.
Treatment folk remedies
pain attacks in stenosis of the ureter is very similar to normal renal colic, which develops in nephrolithiasis.And if there are folk remedies like hot water bottle on the lumbar region, or small amounts of alcohol are quite effective, they are absolutely useless in stenosis.On the contrary, heat treatments promote the formation of large amounts of urine, which leads to increased pressure in the "blocked" kidney, and, as a result, strengthening the pain.
Complications of ureteral stenosis
As already mentioned, the most severe complication of ureteral stenosis is a violation of nefrogematogennogo barrier and getting into the urine in the blood.Along with this, there are local complications that can not be less dangerous.
If a strong increase in pressure in the ureter and kidney can be observed the last gap.This is followed by hitting the urine in the retroperitoneal space, which is accompanied by an inflammatory response and sharp festering.If time does not eliminate the process, sepsis or septicemia may develop, which is also, in most cases, it has a fatal outcome.
Prevention ureteral stenosis
For the prevention of stenosis of the ureter is very important the correct and timely treatment of injuries of the lumbar region.Even in the event of the latter there is an extensive retroperitoneal hematoma, timely drainage of the latter can completely prevent the development of any complications, including stenosis of the ureter.
is worth noting that there are athletes who have blunt trauma waist is considered a professional.These are snowboarders, which in falls, in most cases, land is on the lower back.They are for the prevention of complications were invented special foam pads to soften the blow during the fall.
Ed.urologist, sexologist-andrologist Plotnikov AN