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

Stenosis of the ureter is a congenital or acquired pathology that is characterized by a complete or incomplete narrowing of the ureteral lumen and a violation of urinary evacuation.

Causes of stenosis of the ureter

In its origin, stenosis of the ureter is divided into congenital and acquired. If it is not possible to determine the exact causes leading to congenital stenosis, the etiology of acquired stenosis is known.

Most often, the development of stenosis of the ureter is assisted by trauma of this organ. And, it can be a trauma both from external, and from internal factor. Of the external factors most often stenoses develop against the background of retroperitoneal hematoma, which arises from a blunt impact in the lower back. Gunshot, knife and other open ureteral lesions are much less common, although they are also isolated as causes of acquired stenosis of the ureter.

The cause of internal trauma, which contributes to the development of stenosis of the ureter, are stones that form in the kidneys. In this case, stenosis should not be confused with obliteration - a condition when the stone blocks the lumen of the ureter, thus violating the passage of urine. Renal-stone disease leads to stenosis only in the case when the stone damages the mucous membrane of the ureter, where an inflammatory reaction develops with the formation of a connective tissue.

Symptoms of stenosis of the ureter

Symptomatic of stenosis is caused by a violation of the passage of urine into the bladder and its retention in the cavity of the renal pelvis. This condition is accompanied by the extension of the kidney and the tension of the renal capsule, which leads to the development of an acute pain syndrome. Patients complain of pain in the lumbar region, which first have a cramping, and later a permanent character. Possible irradiation of pain in the external genitalia. Often observed stenosis of one of the ureters, so the pain, as a rule, is localized on one side.

If urine from the kidney is not evacuated in time, it leads to the destruction of nephrons and its entry into the blood. Patients immediately develop a temperature reaction, jaundice of the skin, nausea, vomiting and a sharp smell of urine from the mouth. In the clinic, this condition is called uremia. Without adequate and timely treatment, it ends with the death of patients.

Thus, if a patient has this clinical symptomatology or has a history of blunt abdominal trauma, he needs an immediate consultation with the urologist to avoid the development of acute ureteral stenosis with uremia.

Diagnosis of ureteral stenosis

A general urine test can yield results on the presence of a small amount of blood in the urine, which is the result not of the stenosis but of the injury preceding it. Thus, this method of diagnosis is completely uninformative for the diagnosis of stenosis of the ureter.

"Golden standard" in the verification of this pathology can be considered excretory urography - a study, the essence of which is the radiographic picture of the genitourinary system, after intravenous contrast. As a rule, the results of the study indicate a "break" in the contrast just at the level of stenosis. At the same time, the upper part of the ureter along with the kidney is compensatively expanded and a large amount of urine accumulates in them.

Excretory urography: stenosis of the ureter

Ultrasound examination makes it possible to reveal on the side of the lesion a sharply altered and enlarged kidney. In this case, the ureter itself and the place of stenosis can not be visualized.

An additional modern method of verifying a diagnosis is cystoscopy. It consists in examining the mucous membrane of the bladder with a special optical device. After a local anesthetic of the urethra, a metal tube is inserted along it, which is a cystoscope. The doctor, observing in the eye of the cystoscope, can examine the mucous membrane of the bladder in detail. To verify stenosis of the ureter, cystoscopy should be supplemented by intravenous indigo carmine. The substance is filtered by the kidneys and after a few minutes begins to enter the bladder through the orifices of the ureters. Naturally, with stenosis of one of them, indigocarmine is released only from one hole, which indicates the presence of pathology.

Treatment of stenosis of the ureter

Therapy of this disease, in the first place, should be directed to the evacuation of urine from the bladder. This can be done in several, completely different ways.

The most modern method is stenting of the ureter, which, because of its practicality and minimally invasive, has become very widespread in Europe and the United States. Using the same cystoscope, which performed a diagnostic examination of the bladder cavity, a thin tube is inserted into the cavity of the renal pelvis through the opening of a dysfunctional ureter. If the doctor manages to pass the barrier, urine begins to be released from the vesicle end of the tube. As a rule, it has a more concentrated color and may contain an admixture of blood.

If this method can not be performed, you can benefit from percutaneous drainage of the kidney. For this, under local anesthesia, a puncture of the skin in the lumbar region is performed. Foreign experts recommend performing this procedure under the supervision of ultrasound, but in the absence of the latter one can also start from anatomical landmarks. After the needle is inserted into the cavity of the pelvis, a rubber catheter is placed on it, which is fixed on the skin for a constant outflow of urine.

Well, the last method of evacuation of urine is urgent surgical intervention, which is performed only with all the necessary equipment and with the appropriate qualifications of doctors. The purpose of the operation is not only the evacuation of urine, but also the elimination of the immediate cause of the violation of its outflow. The site of stenosis of the ureter is usually removed, after which the two ends of the organ are sewn together. If the stenosis has a long extension and it is impossible to perform its plastic surgery with its own tissues, artificial prostheses are used to restore the outflow of urine. Techniques are also known where the end of the ureter that extends from the kidney is sutured into the same organ on the other side. In this case, the outflow of urine from both kidneys occurs in one ureter.

Operation to eliminate stenosis of the ureter

Any of the described operations ends with the imposition of a nephrostomy - a special tube, which is excreted on the skin of the waist and through which the outflow of urine takes place. This is done so that in the first days after the operation do not load an ureter anastomosis, which can simply burst.

Any of the treatments is complemented by the mandatory prescription of antibiotic therapy. This is done to prevent secondary infection. After operations on the organs of the genitourinary system, antibiotics of cephalosporin and fluoroquinolone series are most often used, in particular, cefuroxime or ofloxacin. They have a good effect against any pathogenic flora.

Rehabilitation after illness

Rehabilitation of such patients is mainly associated with nephrostomy. If patients have to walk for a few months with a tube that picks up urine, it causes moral and physical discomfort. Firstly, patients need to be taught how to properly care for the stoma, so that the infection of the postoperative wound does not occur. It is recommended to change the dressings daily and treat the place of fixation of the tube with antiseptic solutions based on iodine or alcohol.

In addition, with sluggish wound healing, it is possible to use physiotherapeutic treatment in the form of magnetotherapy, darsonvalization or UHF.To improve regenerative abilities, it is necessary to conduct about ten procedures, lasting 20-30 minutes.

Features of nutrition and lifestyle

Patients are assigned the seventh table for Pevzner, which limits the consumption of alcohol, coffee, strong tea, pepper, salty, sour, fried and smoked products. In addition, patients are forbidden to consume large amounts of water and juices, as well as fruits that increase diuresis. The latter include watermelons or strawberries. The water regime in such patients should be controlled, so it is recommended that they record daily the amount of fluid consumed and the urine withdrawn.

Treatment with folk remedies

A painful attack in stenosis of the ureter is very reminiscent of the usual renal colic that develops with kidney stone disease. And if with her such folk remedies as a hot water bottle on the waist or a small amount of alcohol are effective enough, then with stenosis they are absolutely useless. On the contrary, thermal procedures promote the formation of more urine, which leads to increased pressure in the "blocked" kidney and, as a result, increased pain.

Complications of ureteral stenosis

As already mentioned, the most formidable complication of stenosis of the ureter is a violation of the nephrohematogenous barrier and urine entering the blood. At the same time, there are local complications that can be no less dangerous.

With a strong increase in pressure in the ureter and kidney, there may be a rupture of the latter. This is accompanied by urine entering the retroperitoneal space, which is accompanied by a sharp inflammatory reaction and suppuration. If the process is not eliminated in time, then sepsis or blood infection may develop, which also, in most cases, has lethal outcome.

Prevention of stenosis of the ureter

For the prevention of stenosis of the ureter, correct and timely treatment of injuries of the lumbar region is of great importance. Even if there is an extensive retroperitoneal hematoma when the latter occurs, timely drainage of the latter can completely prevent the development of any complications, including stenosis of the ureter.

It should be noted that there are athletes who have a dull lumbar injury considered professional. These include snowboarders, who when falling, in most cases, land on the waist. They for the prevention of complications were invented special foam shields, which soften the impact during the fall.

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