Disease of the two tubular organs that help urine exit the kidneys and move to the bladder is called dilated ureter. Due to problems with the transport of urine, a person has dangerous disorders in the urinary system. This is a fairly serious ailment.
What is the dilation of the ureter called? Megaureter is an acquired or congenital lesion that causes problems with the functioning of the kidneys, and with bilateral inflammation in humans leads to kidney failure. When tubular ureters expand, urine outflow does not occur, which can lead to inflammation in the kidneys and problems with the circulatory system.
Expansion of tubular process
The walls of the ureter are three-layered, which helps urine slowly move to the bladder. The outer muscular layer includes nerve and collagen fibers that help move urine up to five contractions per minute. With an increase in the size of the ureter, the contractile force begins to decrease, the movement of urine becomes difficult, and the patient's intrarenal pressure increases. Prolonged stagnation of urine provokes the onset of infection, which only worsens the condition of a person. If you do not start treatment of the lesion in a timely manner, then soon there will be problems with the work of the kidneys.
Often, infectious processes in the ureter only increase the expansion of the organ. Dilation of the ureter and renal pelvis is diagnosed by fetal ultrasound.
If after the birth of a child there is no megaureter, then in the future the expansion of the tubular organs will not occur. In the normal state, the diameter of the ureter does not exceed 5 mm, if an expansion was detected during the examination, the doctor prescribes a more extensive examination of other internal organs.
Adolescents with this form of lesion most often present with the following symptoms: the presence of blood in the urine, incontinence, complaints of persistent pain in the abdomen and lower back, the formation of stones in the urinary organs.
Main types of lesions
Specialists identify such forms of damage:
- The primary type is a congenital disease. It occurs when there is a lack of coordination between the work of the muscular and connective tissues of the ureter. In this case, the body lacks the strength to normally move urine through the tubes. A megaureter can appear in a child even at the time of its development in the womb. Most often, the disease of the congenital form appears in boys.
- Secondary type - occurs with high pressure in the bladder. Most often this condition isregular nervous breakdowns, emotional outbursts or chronic cystitis. Most of the diseases, after a comprehensive diagnosis and the appointment of effective treatment, disappear in the first years of a newborn's life.
Reasons for the expansion
There are several reasons for the dilation of the ureter. The main ones include high ureteral pressure and urinary outflow problems. There were situations when, after normalizing the pressure, the ureter continued to be dilated.
Often the patient is diagnosed with congenital insufficiency of the muscles of the tubular organ. In this case, the ureter is greatly weakened and loses contractility to move urine to the bladder. Another reason for this condition is the narrowing of the tubes where they attach to the bladder.
Main causes of enlarged ureter:
- increased pressure inside the tubular organ, which provokes the expansion of the ureter and kidney, as well as problems with the outflow of urine;
- weakness of the membranes in which the muscles are located;
- problems with the formation and development of nerve endings;
- urine is thrown into the pelvis due to narrowing of the ureter.
Characteristic symptoms of lesions
There are a large number of reasons for the expansion of the ureter in a child. In the absence of a primary lesion, the megaureter proceeds in a latent form. In this case, the person has no pronounced symptoms of the disease, he does not suspect anything about his condition. Otherwise, the person may feelunpleasant pains in the abdomen and lower back, you can also easily feel tumor-like formations in him or notice an admixture of blood in the outgoing urine. With the development of an acute form of the lesion, a person is diagnosed with a high number of leukocytes in urine, nausea, vomiting, and body temperature rise.
The most unpleasant symptoms of this disease appear at the 2nd and 3rd stages of its development, it is at this time that a person develops such a dangerous complication as chronic kidney failure or pyelonephritis.
Double urination often occurs in children with enlargement or double lesion. This condition is due to the fact that after the first emptying of the bladder, it is again filled with urine from the dilated organs and the need to urinate again appears.
The second time the urine comes out in large quantities, with an unpleasant odor and cloudy sediment. Due to the fact that the weakened body of a newborn child is very susceptible to various infections, problems with physical development or skeletal anomalies may begin in it. Most often, with the expansion of the ureter in newborns, appetite is lost, the skin turns pale, thirst and urinary incontinence appear.
Degrees of development of the problem
After carrying out diagnostic measures, the attending specialist assesses the condition of the kidneys and prescribes an effective treatment. Doctors distinguish three main stages of the development of the disease:
- Easy stage. There is a moderate expansion of the lower sectionureter. This condition often resolves on its own without outside intervention.
- The average degree of damage. The diameter of the ureter is greatly expanded. With timely and high-quality treatment, you can easily get rid of the problem.
- Severe degree. Megaureter can provoke disturbances in the functioning of the kidneys. In this case, after the examination, the doctor will definitely prescribe surgery for the patient.
How does a small child progress
With the advent of modern equipment in clinics, diagnostics make it possible to determine the presence of a megaureter and anomalies of the genitourinary system even at the stage of intrauterine development. Early diagnosis and identification of a megaureter may lead to unnecessary surgery. This can be explained by the fact that in most cases the process of dilatation of the ureter in a child stops, and the size of the ureter is restored within a few months of the baby's life.
At this age, the doctor should regularly monitor the condition of the baby and prescribe a urine test and ultrasound. Timely detection of the lesion will help to avoid complications and exacerbation of the disease, as well as prevent unnecessary surgery for the child. The baby's organs continue to actively develop for some time, for this reason, in the first few months of life, the doctor cannot always accurately determine the state of the urinary system and the functioning of the kidneys.
When carrying out diagnostic measures, the attending physician should be especiallyattentive and careful, as the risk of error in this case is very high. It is possible to eliminate the lesion only with the timely determination and appointment of effective and correct treatment. It often happens that the expansion of the ureter in a newborn passes on its own. Very often, no outside intervention is required. In an adult with an acute stage of expansion of the left ureter, a mandatory operation is performed.
Indications for surgery
Indications for surgery for dilatation of the ureter in the medical field are divided into two separate types. These are absolute and relative.
Absolute readings
Absolute indications include a disease that is at the 2nd or 3rd stage of development. This condition is very dangerous for the he alth and life of a newborn child and an adult.
Surgical intervention in this case will be the only way to eliminate the disease and completely normalize the patient's condition.
Relative readings
A relative indication is a disease that is at the 1st stage of development and does not pose a particular danger to human life, but significantly affects its condition. For example, it brings fatigue, headaches, reduces efficiency, provokes nausea.
The ureter in this case is minimally dilated. The patient has time during which he can drink a course of effective drugs, which will help prevent further dilation of the ureter. This will help prepare the body.patient for surgery.
Basic research methods
In medicine, dilatation of the ureter is detected at various stages using laboratory methods for examining a patient. The most effective and accurate are excretory urography, radioisotope examination of the kidneys, cystourethrography.
Electronic urography
An effective diagnostic method is urography, which does not cause discomfort to the patient and helps to obtain accurate information about the condition and functioning of the organs, the location of the lesion, the anatomical structure of the ureters, as well as about the dilated areas.
Contraindications to the procedure are severe kidney disease, nervous breakdowns, problems with concentration abilities and other processes in which, due to the accumulation of a large amount of urine in the blood, it is impossible to accurately determine the clinical picture of the disease.
Women carrying a child are prohibited from carrying out the procedure, or only with special indications. For example, if you suspect a malignant or benign formation in the ureter.
Voiding cystourethrography
Another method for diagnosing ureteral dilatation is cystourethrography, which helps to see the presence of dilation and reflux (reflux of fluid from the bladder) on x-rays.
In children who cannot empty their bladder on their own, the procedure is performed under anesthesia. Urine is removed from the bladder by pressing on it with hands.
It is forbidden to conduct such an examination in the following cases: acute form of cystitis, urethritis, as well as hypersensitivity to contrast agents used during the procedure.
Radioisotope survey
This research method is used to evaluate the functioning of the kidneys. A contraindication to the conduct may be the presence of acute diseases of the genitourinary system, intolerance to the components of drugs that are used in the diagnosis. Before undergoing treatment, it is important to find out where the operations are best for dilating the ureter.
Therapy
The most common and effective treatment for dilated ureter is reimplantation. In this procedure, a new anastomosis is placed between the ureter and bladder.
Surgeries can be minimally invasive and open. The first operation lasts for 125 minutes and requires hospitalization of the patient for up to a week. The second type is an operation that lasts the same amount of time, but requires hospitalization of 14 to 16 days.
After the operation, the child may experience the following complications: acute pyelonephritis, colic in the kidneys, wound bleeding and migration of the stent in the lumen of the upper urinary tract.
Recovery after surgery
The patient's recovery has been going on for quite some time. Evaluation of the results of the operation will be remote. Doctors will judge the quality and effectiveness of the surgical intervention performed only after a few years after the operation itself.
It is important to remember that there is nothing terrible and dangerous in the operation. You should not be afraid of it and put it off for a while. According to statistics, success in surgical intervention is observed in 90% of patients. The sooner the treatment of the disease is started, the higher the chance of getting a positive result.
Special attention in the treatment of ureteral dilatation should be paid to its severity. The severity will be determined after receiving the results of clinical diagnostics and a multifactorial assessment by the physician. In normal cases of ureteral dilatation, the patient's condition will recover within a few weeks after the operation. In more complex cases, the patient will need 10-15 weeks for rehabilitation.
To avoid dilatation of the ureter, it is important to monitor the condition of the body and treat diseases of the genitourinary system in a timely manner. It is also important to stop drinking large amounts of fluid if the urinary system does not have time to remove it from the body in time.
