Ureterocele - Causes, symptoms and treatment. MF.

Ureterocele is a congenital anomaly of the development of the genitourinary system, which is characterized by the presence of a baggy protrusion of the ureter near its vesicle end.

Ureterocele

Reasons for ureterocele

Opinions of scientists about the cause of this pathology are ambiguous. Most of them can not be called the only etiological factor. The reason for this is that until now the ureterocele is an unexplored disease. The most common theory in the development of ureterocele is to consider the effect of exogenous factors. Among the latter, it is necessary to allocate not only smoking and drinking alcohol, but also various teratogenic infections, as well as chemicals and medicines.

As for teratogenic and ejibrotoxic infections, for today in obstetrics and infectology a whole group of diseases is allocated, which is called TORCH.It includes not only rubella and toxoplasmosis, but also herpes, cytomegalovirus, and also some other infectious diseases. It is the identification of these pathologies that should be given the most attention when conducting a pregnant woman. For this purpose, blood tests for the corresponding antibodies are performed monthly.

As for chemicals, the situation is less clear here. To avoid a negative effect on the fetus, it is necessary to contact less with different washing, cleaning and bleaching agents. The situation with medicines is a bit more complicated. As you know, the body of a pregnant woman is weakened in the immune system, which constantly affects the health of women. Naturally, in such circumstances, there is a constant need for medication. In such circumstances, it is necessary to ensure that all drugs that are used are allowed to treat pregnant women. It must be remembered that such drugs as hormones and anti-tuberculosis drugs are heading the list of teratogenic medicines.

Symptoms of ureterocele

In fact, the symptoms of ureterocele are very scarce. Even the most experienced urologists can not determine the disease solely by signs. It should be noted that at the initial stages of its development the ureterocele does not have any clinical signs at all. With a strong increase in the saccule protrusion of the ureter wall, it can exert pathological pressure on neighboring organs and tissues. In the first place, the iliac arteries suffer from such an impact. Patients may develop intermittent claudication when, after overcoming a certain distance, sharp pains in the leg begin, which pass after a few seconds of rest.

The second part of the clinical symptoms depends on the stagnation of urine in the ureterocele cavity. There is a characteristic two-stage urination, when in a short period of time after the act of urination the patient again has desires. In addition, there is a very high risk of urolithiasis, since urine in the cavity of the ureterocele practically does not circulate and, due to constant stagnation, sediment precipitates out of it, which after a while turns into stone.

It should be noted that despite the inherent etiology of the disease, it can arise at any age. If the patient has the above symptoms, he must immediately contact the urologist, in the first place, to establish the correct diagnosis and the appointment of a correct treatment.

Diagnosis of ureterocele

Laboratory research methods are practically uninformative. An exception should be considered only the situation with secondary urolithiasis, when in the general analysis of urine there may be traces of sand. However, with a large stone that moves and damages the mucous membrane, a small amount of blood may appear in the general urine test, which, more often than not, can not be seen with the naked eye.

Cystoscopy or excretory urography can be used to verify the diagnosis. As for cystoscopy, it consists in introducing a special optical device into the bladder cavity. The surgeon examining the mucosa can see an additional cavity that originates from the vesicle end of the ureter.

In excretory urography, which is performed radiographically, after intravenous administration of contrast medium, it is possible to reveal a round or oval formation that is filled with contrast and connects to one of the ureters.

Treatment of ureterocele

Treatment of this disease is only after the appearance of the first symptoms. It consists exclusively in surgical intervention, which today can be carried out in different ways.

In small ureterocele sizes, when it does not have any pathological effect on surrounding tissues, cystoscopic obliteration of the additional cavity may be performed. After the introduction of a special optical device into the bladder, it is directly ureterocele, the tip of the cystoscope is immersed in it, from which a special substance is introduced. After solidification, this composition closes the cavity of the ureterocele, turning it off from the circulation of urine.

With a large size of the pathological protrusion, especially when it has a pathological effect on the surrounding tissues, an advantage is given to a conventional cavitary operation. In the course of the operation, after a cut of the skin in the lumbar region, a blunt and acute pathway is excreted by the ureter, on which the pathological protrusion is localized. The latter is bandaged at the base and cut off with a scalpel. The operation ends with a layer-by-layer suturing of the wound and the application of an aseptic bandage.

Operation to eliminate ureterocele

Rehabilitation after illness

In principle, this disease can not be considered especially dangerous for life, therefore its rehabilitation is not paid much attention in urology. Classically, antibacterial prophylaxis of secondary infection is used, for which groups of drugs such as cephalosporins and fluoroquinolones are used.

In addition, patients with a similar pathology for the prevention of urolithic illness are recommended to visit such sanatorium resorts as Morshin or Saki, where active mineral treatment and prevention of the above pathology is carried out. Also, patients need to monitor the diet of their food, especially for the amount of liquid consumed.

Nutrition and Lifestyle of

In principle, there is no acute need for therapeutic nutrition, since it has little effect on the patient's condition and on the period of recovery after surgery. As for the lifestyle, for some time he is limited to wearing a urethral catheter, which is necessary to ensure that the increased pressure in the bladder does not have a pathological effect on the sutured ureter and does not lead to a postoperative rupture of this organ.

Treatment with folk methods

Folk treatment of ureterocele is not common because of the complex diagnosis of pathology. All attempts to use a variety of diuretics and herbs are directed solely at eliminating the symptoms of the disease, but in no way its causes. Therefore, the appeal not to professionals, but to folk healers, only delays time and leads to the progression of pathology.

Complications of ureterocele

As already mentioned, a strong increase in ureterecele can lead to compression of structures such as the iliac artery, which results in intermittent claudication. As a rule, such patients become patients not of urologists, but of vascular surgeons. Quite often they are exposed to the wrong diagnosis, which can result in even unnecessary surgical intervention. Therefore, it must be remembered that such a symptom as intermittent claudication can speak not only about the vascular, but also about the urological disease.

The second most frequent complication of this disease is urolithiasis. As already mentioned, it develops due to the constant stagnation of urine in the cavity of the ureterocele, which leads to the loss of urinary sediment and the formation of a stone. At the initial stages of the disease, this clinical condition may not be accompanied by any symptoms. As a rule, they appear after the calculus begins to irritate the mucous membrane of the bladder, which is accompanied by severe pain syndrome and secretion of a small amount of blood through the urethra.

All other complications of this disease, as a rule, arise after an operative intervention. Most often, this is a rupture of the ureter by the scar. It occurs when immediately after surgery, the urethral catheter will not be delivered to the bladder. In such a situation, the pressure in the bladder may increase and, consequently, its rupture.

Prevention of ureterocele

It is natural that the prevention of congenital pathology should be carried out before the birth of the child. First and foremost, it should be the diagnosis and treatment of teratogenic infections, such as rubella, herpes, cytomegalovirus and toxoplasmosis. After this, it is necessary to pay attention to the contact of the pregnant woman with chemicals and the use of medicines.

Prognosis for ureterocele

Prognosis for life is favorable. Regardless of the form, stage and treatment of the pathology, it can rarely threaten the patient with a fatal outcome. Even complex clinical situations, for example, ureteral rupture, with appropriate treatment do not pose the least risk to the patient's health.

Forecast for working capacity - favorable. Before and after surgery, patients can be at any job, even if it is associated with physical labor.

The prognosis for recovery is favorable. With a timely diagnosis and a properly performed operation, the period until complete recovery lasts approximately 2 weeks. After this, the patients are removed from the surgical wound. In some cases, when there was poor care for the operating wound or insufficient antibiotic prophylaxis, suppuration of the postoperative wound may be noted. In such cases, special ointments, such as levomecola, are prescribed, and the total period of treatment lasts up to one month.

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