Pathology in the genitourinary system associated with narrowing of the urinary canal is quite common. This disorder is called ureteral stricture. The pathological process can affect the organ both completely and partially. Due to a violation in the functioning of the urination system, urine is either not excreted at all, or it happens slowly. Acquired and congenital strictures occur.
Description of pathology
The ureter is a hollow tubular organ that connects the kidney to the bladder (in most mammals).
It starts from the narrowed area of the renal pelvis, where the urine formed in the kidney flows. Its excretory end ends in the bladder wall.
For a he althy person, anatomical or physiological narrowing of the ureter is considered an acceptable norm. A similar phenomenon occurs due to the elastic properties of its wall. However, in the event of a stenosis or stricture, the changes begin to acquire a fibrous-sclerotic form. As a result of this pathological process, there is a violation of the submucosa, as well as the muscular and outer walls of the ureter. At the same time, some muscle elements die off and are replaced by scar tissue, which is not able to perform any functions, as it is atrophied.
Disturbance of organ function
The lumen of the urinary duct at the site of occurrence of ureteral stricture is reduced, which disrupts the functioning of the organ in normal mode. Urine cannot be completely excreted from the body and begins to accumulate in the bladder, over time provoking increased pressure on the ureter. In the future, it is stretched and elongated. In some cases, it comes to curvature of the ureter. In the absence of proper treatment, the pathology affects the kidneys.
Ureteral stricture can develop in any area of the organ. Most often, the pathology is localized in the gap between the bladder and the ureter. In addition, there are cases of detection of stricture between the ureter and the pelvis.
Varieties of strictures
Narrowing of the ureter can take on different forms depending on the area of localization of the pathology, as well as on the nature of the disease. First of all, there are acquired and congenital stenosis. The latter appears in the process of intrauterine development of the unborn child.
A pathological process may occur due to thickening of the walls in certainplaces. Congenital ureteral strictures appear as a result of some abnormalities in the development of the fetus, namely:
- Kinking due to the curved shape of the ureter.
- The appearance of a membrane in the valve of the ureter, which provokes the accumulation of urine in the bladder.
- Ureterocele. This disease is characterized by a narrowing of the lumen in the lower part, while the ureter expands, and in some cases falls into the cavity of the bladder.
- Squeezing vessels.
- The formation of diverticula, which provoke protrusion of the lower part of the ureter.
Acquired form of narrowing of the ureter can occur under the influence of various factors, depending on the state of human he alth. Depending on the area where the stricture was localized, right-sided and left-sided stenosis are distinguished. It also happens that both sides of the ureter are affected. Also, stenosis can be localized both in the upper part of the ureter and in its lower part, where the transition to the renal pelvis occurs. If the pathological process develops in the middle section, then both the upper and lower parts of the organ are affected.
Reasons
There are a number of factors that cause narrowing of the lumen of the ureter. These are developmental disorders at the genetic level in the case of a congenital form of pathology, which causes the formation of scar tissue instead of muscle walls. The acquired form of the disease can cause a variety of reasons, but most often a factorrisk are injuries.
Provoking factors
Factors that can cause the development of ureteral stricture are:
- The formation of kidney stones. This belongs to the category of internal injuries. Urolithiasis causes inflammation, and mucous membranes are easily damaged by stones, which leads to scarring.
- External injuries in the lumbar spine. As a result, a hematoma appears behind the peritoneum, which later is the basis for a stricture.
- Injury sustained during surgery.
- Radiation therapy, as well as radiation damage.
- Tuberculosis, inflammation in the ureter.
Ureteric strictures should be investigated by a doctor.
In addition, in some cases, pathology appears as a result of receiving gunshot or stab wounds. Also, self-treatment of sexually transmitted diseases can lead to injury to the ureter. Men are more prone to injury and excessive physical exertion, so they are more likely to have strictures. If any of the listed factors are excluded, then the doctor concludes that the disease is congenital.
ICD-10 code for ureteral stricture - N13.5.
Symptoms
As a rule, symptoms and severe pain accompany bilateral stenosis. Unilateral stenosis, on the contrary, mostly proceeds in a latent form. For this reason, it is almost impossible to diagnose the disease at an early stage of its development. With bilateral lesions, the following are observedsymptoms:
- Increased pressure in the arteries.
- Pain in the lumbar region.
- Nausea and vomiting.
- Convulsive syndrome.
- Excretion of a small amount of urine.
- Pain while urinating.
- Increase in body temperature, which indicates an inflammatory process in the body.
- The presence of blood in the urine.
Ureteral stricture symptoms are very uncomfortable.
In the absence of proper treatment, the pathological process can progress and spread to adjacent organs, including the kidneys. Due to the incomplete excretion of urine from the body, the risk of stagnation increases, which will eventually lead to urolithiasis, pyelonephritis, hydronephrosis, and kidney failure in a chronic form. It is important to identify the pathology in a timely manner and receive qualified medical care.
Diagnostic methods
To get a complete clinical picture, it is necessary to schedule a detailed examination of the patient. Diagnostic procedures include blood and urine tests, ultrasound of the genitourinary system. In addition, the patient is prescribed computed tomography and magnetic resonance imaging. Endoscopy is contraindicated if the patient has an inflammatory process in the vagina, uterus, urethra or prostate gland.
Urethrography is considered the most informative and common research method for ureteral stricture. The procedure is an x-raycontrast study. This technique makes it possible to identify those areas in which there is stagnation, as well as to localize the presence and position of narrowed areas. The contrast is injected directly into the urethra or intravenously.
Preparation for urography
Urography is considered an effective, safe diagnostic method. The study is prescribed if there is a suspicion of kidney pathology, bladder disease, problems with filtration and excretion of urine.
The basic rules for preparing for urography will be as follows:
- 3 days before the procedure, the patient should refuse food that provokes excessive gas formation.
- A radiopaque allergy test must be performed without fail.
- Meals should be no later than 8 hours before the study, do not drink too much liquid throughout the day.
- Don't eat in the morning.
- In the office, you need to remove metal products, jewelry, empty your bladder as directed by the doctor.
- If there is anxiety shortly before the urography, you can drink a sedative (sedative) remedy.
Therapy
After a thorough examination and clarification of the diagnosis, the patient is prescribed the necessary treatment. The main goal of therapy is the normalization of urine excretion. The treatment regimen is selected based on the results of the studies. It is also important to consider the general condition of the kidneys and the genitourinary system. Another important factor in choosing a treatment isstricture size.
Restriction of the ureter is not amenable to treatment at home, as well as by methods of traditional medicine. Contrary to popular belief, warming up the affected area should not be done, as the pain from this can become more intense.
One of the effective methods of treatment is plastic surgery in urology centers. This is a rather complicated procedure, with a long rehabilitation period, so it is prescribed only as a last resort. The operation is not suitable for every patient, as it has a number of contraindications.
Another method of treatment is ureteral bougienage. A procedure is performed using a metal rod that is inserted into the ureter and expands it. The procedure is very painful, and the effect of it is short. Bougienage is rarely used.
Plastic replacement method
The plastic replacement method is also used in urology centers. This method is suitable for the treatment of small strictures, the size of which does not exceed 20 mm. The operation consists of making an incision and replacing the scars with tissue from the patient. In addition, an optical urethrotomy using a cystoscope is used. Any intervention to treat stenosis must be agreed with the attending physician and carried out under the supervision of a qualified surgeon.
Pathology is quite serious, not treatable with medication or folk methods. If surgery is not performed, complications may occur that affect the kidneys and other organs.
Prevention and prognosis
Stenosis develops rapidly, especially when trauma precedes it. A hematoma forms in the affected area, which must be detected and drained. With proper first aid, the formation of strictures is excluded. Any, even a minor injury to the lower back requires a referral to a specialist for examination and examination. It is important to avoid injury to the pelvic area when playing sports. It is important to use special protective shields that can soften the blow.
The sooner surgery is performed after the detection of strictures, the better for the patient and the less likely complications will develop. In addition, this will shorten the recovery period, and the operation itself will not be so painful. An important point of proper rehabilitation is compliance with all the prescriptions of the attending physician.
Complications
If the above conditions are not observed, complications arise that can affect the functioning of the genitourinary system and other organs. Surgery can also have consequences if the patient's tissues have not grown together correctly or have not taken root at all.
Untreated can lead to the development of pathologies such as cyst or kidney failure, as well as hydronephrosis, when the renal pelvis is dilated. In some cases, cystitis appears against the background of strictures, as well as kidney stones.
