Aplasia of the ureter - Causes, symptoms and treatment. MF.

Aplasia of the kidney and ureter is a congenital anomaly of the development of the genitourinary system, which is manifested by the complete absence of one or two ureters. There is a one-sided and two-sided aplasia of the ureter. The second form of the disease is incompatible with life, therefore only one-sided ureteral aplasia is considered in the urological clinic.

From left to right: aplasia of the left kidney and ureter, aplasia of the right kidney and ureter with the ureteral anus position on the left, aplasia of the left kidney with retention of part of the ureter( incomplete ureteral aplasia)

Causes of ureteral aplasia

Reliable reasons for the development of the anomaly of the genitourinary system are difficult to name. Scientists say that both internal and external factors play a role in this. Among the internal factors can be identified the violation of hormonal metabolism in pregnant women, concomitant chronic diseases, accompanied by anemia and hypoxia, as well as systemic connective tissue disease.

As for external factors, it is believed that in the development of ureteral aplasia, as well as other anomalies in the development of different organs, infectious diseases, especially rubella and toxoplasmosis, persistent stress and traumatic injuries during pregnancy take part. Also, in the United States of America, special studies have been conducted that have proved that ionizing radiation affects the developmental defects of the internal organs, including the kidneys.

Almost always aplasia of the ureter is combined with aplasia or kidney agenesis on the same side. In those rare cases when patients are born with a normal kidney and the absence of a ureter, it will atrophy for a short period of time.

Symptoms of ureter aplasia

As a rule, ureteral aplasia has an asymptomatic course. Often it is an accidental finding in the examination of the organs of the genitourinary system about some other disease.

At the same time, if there is incomplete ureteral aplasia, during which a small reservoir lined with the vesicle epithelium leaves the bladder cavity, infection may occur. The reason for this is the constant stagnation of urine in this process. In such a situation, patients begin to note pain in the lumbar region and ileum, increased body temperature, as well as urination disorders, in the form of frequent urination and urination.

If a person has any congenital developmental anomalies or one of his relatives suffers from a hereditary pathology of the kidneys, he must also be examined for the health of the genitourinary system. In addition, the above complaints are a direct indication for the patient's treatment of a urologist.

Diagnosis of ureteral aplasia

In a general urinalysis, which is carried out by all without exception, patients with pathology of the genitourinary system, it is possible to detect a small number of erythrocytes and leukocytes. It is worth noting that such tests are only observed when the ureter is infected, while with latent flow the urine is absolutely "calm".

The "gold standard" in verifying the diagnosis of ureteral aplasia can be considered excretory urography. The method is based on intravenous contrast and subsequent X-ray examination of the urogenital system. In most cases, the contrast is marked only one point. With a partial ureteral aplasia, a thin strip of contrast can be detected, which indicates a partial patency of the ureter.

Excretory urography: ureteral aplasia

Ultrasonic examination, which is performed for all patients with pelvic pathology, reveals a decrease in the size or complete absence of the kidney on the side of the lesion. Since ultrasound makes it possible to visualize only the parenchymal organs, the ureter itself, or rather its absence, in most cases remains unnoticed.

In some hospitals, if the equipment and qualifications of doctors allow, cystoscopy of the bladder is also performed. It makes it possible to see the orifice of the ureter, which in the case of the aplasia of the latter, is completely or partially closed.

Treatment of ureteral aplasia

In the asymptomatic course of the disease, patients are shown only a periodic observation from the urologist. They do not need specific treatment. When infection of the ureteral stump, the symptoms of which have been described above, an operation is recommended to remove this formation.

An operative approach to the lateral surface of the abdomen is the incision. Blunt fat is passed through the blunt and acute pathway and a bladder is released from the surrounding tissues. It is infected with the ureteric stump and binds at the base. Next, the node is immersed in the wall of the bladder. To do this, a suture seam is applied around the stump, which creates a loop, into which the ureter is immersed.

The next step in the operation is to remove the remaining part of the ureter. It is removed in exactly the same way as in the previous case. After ligation of the ureter, the latter is cut off. The altered kidney, which is located in the depth of the soft tissues of the retroperitoneal space, does not move, as its removal threatens the risk of bleeding.

Drainages are installed in the retroperitoneal space, which are discharged to the skin of the back surface of the abdomen. The aim of their formulation is to remove residual blood and inflammatory fluid.

The operation ends by layer-by-layer suturing of the operating wound and the application of an aseptic bandage. In some cases, a urethral catheter is placed in order not to create pressure in the bladder.

Because the indication before the operation was the infection of the bladder, in the postoperative period, active cystitis treatment is necessary. To do this, antibiotics of a wide range of action, such as ceftriaxone or gatifloxacin, are administered, which are administered intravenously and intravesically via a previously established urethral catheter.

Rehabilitation after illness

Any surgical procedures through the retroperitoneal space are quite traumatic, so patients must first observe bed rest after the operation. At this very stage, the proper maintenance of the surgical wound for the prevention of secondary infection is very important. A daily change of aseptic dressings helps prevent infection at the surgical site.

Together with other methods of rehabilitation, physiotherapeutic treatment is actively used, which includes the use of magnetotherapy, darsonvalization, electrophoresis of pain killers and UHF.Contraindications for the application of physiotherapy can serve already developed infectious processes at the site of the surgical wound.

Features of nutrition and lifestyle

Because patients with ureteral hypoplasia live in fact with one kidney, they need to prevent her diseases. Such patients are undesirable to walk in damp weather, drink cold drinks during the hot season and to contact patients with colds. The reason for this is that the tonsillitis that occurs in such patients often gives complications to a single kidney, which ends with glomerulonephritis. This disease has a chronic course and, in the absence of treatment, inevitably ends with kidney failure.

Treatment with folk remedies

Those diseases that require surgery for their treatment, a priori can not be succumbed to folk therapy. Often, such treatment, on the contrary, leads to a worsening of the general condition due to a delay in normal therapy. Therefore, with such a disease it is necessary to immediately seek help from a qualified specialist, and not to test fate, checking on yourself all the resources of traditional medicine.

Complications of ureteral aplasia

The most common complication of this disease is the infection of the altered ureter. As already mentioned, it is manifested by minor pain in the lower back and violation of urination. In the absence of treatment, a purulent inflammation develops in the ureter cavity, which can spread to the fatty tissue of the retroperitoneal space. In this situation, patients note a sharp soreness in the lower back, which is accompanied by a sharp rise in body temperature to febrile figures.

When bladder infection occurs, casting of contaminated urine into a single kidney can also occur, which results in the development of pyelonephritis. Since inflammation develops in a single kidney and the urinary process is not compensated for by a second kidney, acute renal failure develops immediately in patients. In the absence of adequate treatment in the intensive care unit, this clinical condition necessarily ends with the death of the patient.

Prophylaxis of ureteral aplasia

Prevention of this disease, in the first place, should be handled by pregnant women. During the carrying out of the child, the mother is not allowed to consume alcoholic drinks, embryotoxic drugs and stay in the zone of increased radiation contamination. In addition, frequent stress and trauma during pregnancy can also contribute to the birth of children with multiple defects, including the genitourinary system.

If at birth the child has been diagnosed with this defect, he needs to undergo periodic examinations with the urologist. This is done in order to monitor the functional state of the kidney and to determine the indications for surgery promptly.

Prognosis for ureteral aplasia

The prognosis for life, in most cases, is favorable. Fatal results are noted in those rare cases when inflammation of a single kidney occurs.

The prognosis for recovery is unfavorable. Despite the fact that it is technically possible to reconstruct an altered ureter, this operation probably does not make any sense, since it is possible to restore the altered kidney only by transplantation, which is also not practical in the normal functional state of the second organ.

The prognosis for working capacity is unfavorable. All patients with this pathology are on the third group of disability, which allows them to engage only in those activities that do not require physical activity. Such patients are on lifelong pensions and do not need a periodic medical re-commission *.

* According to the Decree of the Government of the Russian Federation of February 20, 2006 No. 95 "On the procedure and conditions for the recognition of a person with a disability"

Ed.the doctor the urologist, the sexologist-andrologist Plotnikov А.N.