Ureter valves - Causes, symptoms and treatment. MF.

Uretil valve is a duplicate of the ureteric mucosa that occurs, as a rule, in its lower parts and complicates the normal evacuation of urine into the bladder.

Causes of ureter valves

The cause of ureteral valves is the fact that at birth the ureter has the same length as an adult. This contributes to the fact that it acquires a spiral shape, and in its lower part, valves are formed, which can consist only of the mucous membrane or of all layers of the organ wall. Since the neonatal lumen of the ureter is much wider than that of an adult, these valves do not interfere with a normal outflow of urine. Normally, about four years of age, the valves are reduced, and the patient does not even know about the existence of the latter.

Ureter valves

There are often clinical cases when the valves do not disappear with age and this prevents a normal outflow of urine. First it is a partial ureteral obstruction, which eventually turns into a full.

In addition, the literature describes cases when the valves of the ureter had acquired origin. In this situation, the cause of the valve was ureteral injury, which resulted in excessive regeneration of the mucosa with the formation of a valve.

Symptoms of ureter valves

Symptomatic disease is determined by stagnation of urine in the cavity of the renal pelvis. As a result, the renal capsule stretches, which is manifested by very severe pain in the lumbar region. Until the moment of complete obturation of the ureter, the pain syndrome is of a permanent moderate nature. With the complete closure of the ureteral lumen, the symptom acquires the character of renal colic. In such a situation, patients are restless, they complain of a sharp deterioration in the general condition and severe pain in the lumbar region.

With prolonged course of the disease, when there is a constant stagnation of urine in the cavity of the renal pelvis, patients can develop kidney stones. Then there are typical signs of kidney stone disease, when patients are concerned about periodic pain in the lumbar region, which is accompanied by a violation of urination.

In the absence of treatment, the valves of the ureter can lead to quite serious consequences, therefore, if a person develops the above-described clinical picture, he should immediately contact a urologist for diagnosis and treatment.

Diagnosis of ureter valves

At the first stage of medical research, when general blood and urine tests are performed, changes can not usually be detected. Only with the addition of nephrolithiasis, in patients, there may be an increased amount of salts in the general analysis of urine.

Different methods may be used to verify the diagnosis, but excretory urography is considered to be the most effective. To perform it, a contrast agent is injected intravenously, which is then excreted by the kidneys. If, at the same time, the radiographic examination of the pelvic organs is performed, one can see the relief of the mucous membrane of the ureter, on which, when the valves are formed, a protuberant protrusion of its wall is noted.

Excretory urography: ureter valves

As already mentioned, the ureter valves are mainly formed in the lower part of the ureter. This gives a chance of finding the latter during cystoscopy. For this purpose, a special optical device is inserted into the bladder cavity and the doctor examines its mucosa. With ureteral valves, there is no urine from one kidney, and, with a particularly low ureteral location, you can see the valve itself, which is visualized as a small protrusion of the mucous membrane.

Treatment of ureter valves

Uretil valves need treatment only if there is an obstruction of its lumen and the patient has symptoms of renal colic. First of all, patients undergo cystoscopy with an attempt to perform ureteral stenting to restore normal urine outflow. The stent is a tube of minimum diameter, which, with the help of a cystoscope, is inserted into the cavity of the renal pelvis, and the other end remains in the lumen of the bladder. If the urologist succeeds in passing the ureteral obstruction, the tube can remain in its cavity for up to three months.

If stenting is ineffective or it is simply impossible to perform it, the patient is recommended surgical intervention. After access to the ureter, which is performed by the retroperitoneal technique, focusing on the data of additional research methods, find the place of the formation of the valve. The ureter is opened, and the valve is excised, suturing the mucous membrane.

With multiple valves of the ureter, it is simply impossible to excise them, so they resort to partial ureter resection. Passage of urine is restored by stitching the ends of the ureter or using an artificial prosthesis made from hypoallergenic indifferent material.

In a situation where it is not possible to conduct an operative intervention, and the threat of urosepsis development increases with every minute, the patient undergoes a puncture of the renal pelvis. Under local anesthesia in the lumbar region, a puncture of the skin and soft tissues is performed before the catheter enters the renal pelvis cavity. In modern urological clinics, this procedure is carried out under the supervision of ultrasound. In the absence of this method of visualization, it is performed on anatomical landmarks. After a puncture of the pelvis, a special catheter is inserted along the needle, along which urine outflow is carried out. She is there until the moment of operative intervention, and with absolute contraindications to the latter, for life.

Rehabilitation after illness

First of all, rehabilitation after surgery is based on antibacterial prevention of secondary infection of the wound. Quite often, traces of urine can enter the surgical field, which is a good substrate for the development of infection. To prevent the latter, it is necessary to take antibacterial preparations of a wide spectrum of action, such as ceftriaxone or ampicillin, within one week.

Widely after kidney surgeries, physiotherapy methods are used. The purpose of their application is the prompt healing of the postoperative wound.

Features of nutrition and lifestyle

After surgery on the kidney, all patients are assigned a dietary table number 7 according to Pevzner. Feature of this diet is to limit the consumption of fried, fatty, salty and acidic foods. Thus, the burden on the kidneys decreases, which improves the regeneration process and promotes a speedy recovery.

Also, all patients within three months are not allowed to perform work that requires strong physical stress. If their immediate profession is related to physical work, then it is recommended that patients change their place of work.

Treatment with folk remedies

As already mentioned, an urgent invasive intervention is necessary to unload the kidney in the event of acute ureteral obstruction. Thus, conservative methods of treatment, including folk, can not be considered effective. And the appeal to such specialists only delays the time, which could be spent on adequate professional medical care.

Complications of the ureter valves

The most frequent and most dangerous complications for ureteral valves are full ureteral obturation, the result of which is renal colic. With prolonged retention of urine in the renal pelvis, urinary toxins enter the blood, which is the cause of urosepsis, a common infection of the blood. If at this stage the patient is not transferred to the intensive care unit for emergency care, then the clinical condition can end fatal.

Clinical cases have been described, when, due to ureteral obturation, the rupture of the ureter occurred. This led to inflammation of the adipose tissue of the retroperitoneal space. In the absence of treatment, such inflammation usually turns into purulent melting of the retroperitoneal tissue and ends with the same infection of blood.

If patients have not acute but chronic urinary retention in the cavity of the renal pelvis, then they develop kidney stone disease. Such patients, in addition to eliminating the ureter valve, also need treatment for kidney stone disease. When treating them, you must remember that the cause of obturation can be not a valve, but a stone. This is very important when choosing the tactics of treatment, as stone obturation can be eliminated without surgery.

Prevention of ureter valves

As already mentioned, from the neonatal period and up to four years, the valves of the ureter are a physiological phenomenon. The reasons why this rudimentary organ does not disappear with time, it is a lot of and for today it is impossible to allocate any certain. It is very important in childhood to follow the physical and psychomotor development of the child, since it is his delay that can cause the development of the valves of the ureter.

In addition, it is necessary to undergo periodic examinations with a urologist who can in time reveal the valves of the ureter and prevent the development of complete obturation.

If a patient, by prophylactic examination, has found ureteral valves, he needs to undergo periodic studies with the urologist in order to determine the dynamics of the pathology. If there is a tendency to progression of the valve enlargement, the patient should better perform a routine surgery, after which there are fewer complications than after the urgent one.

Prognosis of ureter valves

Prognosis for life is favorable. The exception may be those rare cases when urosepsis develops.

Forecast for working capacity - favorable. As a rule, even the performed surgical intervention is not the reason for the job change. An exception may be a period in the first three months after surgery, when it is necessary to avoid strong physical stress.

With timely access to a specialist and adequately conducted treatment, the prognosis for recovery is also favorable.

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