Neuro-muscular dysplasia of the ureter - Causes, symptoms and treatment. MF.

Neuro-muscular dysplasia of the ureter is a congenital or acquired anomaly of development that manifests itself in the violation of the neuromuscular apparatus of the organ and, consequently, its peristalsis.

Neuromuscular dysplasia of the ureter

Causes of neuromuscular dysplasia of the ureter

To date, the causes of congenital neuromuscular dysplasia of the ureter are not known exactly. Scientists put forward a lot of theories, but none of them can be called reliably probable. It was found that alcohol and smoking during pregnancy are of great importance in the development of pathology. It has also been shown that non-dietary fatty foods, radioactive radiation, certain chemical and medicament agents can also affect the development of congenital neuromuscular dysplasia of the ureter.

As for the acquired form of the disease, here the list of immediate causes is more or less known. It is believed that the most common cause of neuromuscular dysplasia of the ureter is obstruction of its suprubulary department. The cause of the obstruction, in turn, may be a urinary stone or a tumor of this organ.

The influence on the development of the disease and inflammatory processes is not ruled out. Among them, in the first place, it is possible to isolate pyelonephritis, in which the infectious process can spread to the ureter.

Trauma of the ureter and strong emotional stress can also be the cause of neuromuscular dysplasia of the ureter.

Symptoms of neuromuscular dysplasia of the ureter

Symptomatic disease depends on its stage. At the initial stages, when the kidney function is not broken, patients can not make any complaints at all. As a rule, they have a pathological process recorded with a planned preventive examination or when calling a doctor about some other pathology.

The first clinical symptoms are noted after the patient's impaired renal function. Patients are beginning to worry about general weakness, malaise, constant headaches. When examined, there is a marked paleness of the skin and an unpleasant odor of acetone from the mouth. Later, edema may appear, which are localized, usually on the lower limbs and around the eyes.

Pain syndrome, which, in theory, should accompany the disease, is often absent. The reason for this is a violation of the sensitivity of the ureter, which is considered one of the directions of the pathogenesis of the disease.

A cardinally opposite situation can occur when the ureter ruptures when urine fills the retroperitoneal space. Then patients complain of a sharp and severe pain syndrome that occurs on one side of the lumbar region.

If a person has at least one of the above symptoms, he should immediately seek advice from a urologist, since the clinical picture of the disease is not always comparable with the morphological changes. In other words, even with minimal symptoms, the patient may have a serious stage of neuromuscular dysplasia of the ureter.

Diagnosis of neuromuscular dysplasia of the ureter

General blood and urine tests for neuromuscular dysplasia of the ureter, as a rule, remain not informative. Exceptions may be those cases when the disease has arisen due to ureteral obturation with a kidney stone.

For accurate diagnosis, excretory urography is used. It consists in radiographic examination of the pelvic organs after intravenous injection of contrast medium. The pictures manage to find a huge ureter, which can even exceed the size of the bladder. With a serial X-ray study, attention is drawn to the prolonged stagnation of urine in the ureter and poor evacuation of the latter.

Excretory urography: neuromuscular dysplasia of the ureter

Ultrasonic examination makes it possible to identify a large reservoir in the retroperitoneal space filled with a substance similar in consistence with a liquid.

If you examine the bladder mucosa with a special optical device called a cystoscope, you can see a mild hyperemia of the latter, as well as a large relaxed ureteral opening, from which a lingering jet of urine emerges.

Not so long ago in urological practice the method of urokinematography was widely used, which is based on the registration of peristaltic contractions of the ureter. As a rule, with neuromuscular dysplasia of the ureter, there are quite rare peristaltic waves or, in general, the absence of the latter.

Treatment of neuromuscular dysplasia of the ureter

A variety of urological studies have helped to come to the conclusion that any conservative treatment of neuromuscular dysplasia of the ureter is absolutely futile. In this situation, the only effective method is surgical intervention. To date, more than 200 methods have been proposed, among which the most effective one is really difficult to choose.

Whichever method is used to perform the operation, its purpose is to reduce the size of the ureteral cavity and restore the normal passage of urine. As a rule, in most cases resection of the distal ureter is performed, which, most often, is the most extensive. After this, the passage of urine is restored by sewing the stump of the ureter into the wall of the bladder. The operation ends with a layer-by-layer suturing of the wound and the application of an aseptic bandage.

Rehabilitation after illness

Antibacterial prophylaxis of secondary infection is mandatory, since it is known that urine, getting to the area of ​​the operating wound, creates very good conditions for the development of infection. To this end, antibacterial preparations of a wide spectrum of action from the group of macrolides or fluoroquinolones can be used. The combination of azithromycin and ofloxacin is universally recognized throughout the world.

For better healing of the postoperative wound, daily dressings should be performed with treatment of the surgical rumen area with antiseptic alcohol solutions. It is not excluded the use of physiotherapeutic methods of treatment, such as magnetotherapy or darsonvalization.

Features of nutrition and lifestyle

Since the violation of kidney function is a regular stage in the development of neuromuscular dysplasia of the ureter, all patients with this problem must be assigned a dietary table number 7 according to Pevzner. Such patients are not allowed to consume salty, acidic, fried and peppery foods that can stimulate diuresis, disrupting the function of the kidneys.

For approximately three months after surgery, patients are advised to adhere to a sparing regimen with limited physical stress. A heavy load on the anterior abdominal wall and the lumbar region can cause seam rupture and a discrepancy in the postoperative wound.

Treatment with folk remedies

Treatment with folk remedies for neuromuscular dysplasia of the ureter is an absurd concept because it is simply impossible to put a similar diagnosis without additional methods of research. All those procedures that are often recommended by traditional healers do not bring any positive result and are a waste of not only time, but also money. Plus, delaying normal treatment can only aggravate the problems and lead to more serious consequences and complications.

Complications of neuromuscular dysplasia of the ureter

The most frequent complication of neuromuscular dysplasia of the ureter is chronic renal failure, which develops due to the constant stagnation of urine in the cavity of the renal pelvis. Over time, this leads to a thinning of the renal parenchyma and impaired renal function. Patients gradually progressing to general symptoms, which, in the end, ends with a kidney coma. In the absence of adequate treatment at this stage, the outcome of the disease is usually lethal.

Less vigorous, but no less frequent complication is vascular ureter reflux. This clinical condition is a failure of the ureteral valve, in which urine from the bladder cavity begins to be thrown back into the ureter. In principle, the complication can not be called unpredictable, since it is quite predictable in the development of neuromuscular dysplasia of the ureter.

In the clinic of pathology, there may be a rupture of the ureter. As a rule, this happens with excessive filling of the ureter and the impact of a minor external stimulus, such as a blunt trauma of the lumbar region. Urine, getting into retroperitoneal space, causes the development of a severe pain syndrome, which in some cases can even cause a pain shock. Ruptures of the ureter is an absolute indication for surgical intervention. If the patient refuses the surgery or is unable to conduct the surgery, 100% mortality of patients is noted.

Prophylaxis of neuromuscular dysplasia of the ureter

In the congenital form of the disease, prevention should be based, first of all, on eliminating all those negative factors that can cause the development of congenital anomalies.

Prophylaxis of the acquired form of the disease consists in the timely treatment of those pathologies that can lead to neuromuscular dysplasia of the ureter. First of all, it is urolithiasis and tumors of ureters. If these pathologies are identified at early stages and the necessary therapeutic tactics are taken on time, then there is a high probability that in the future the patient will not know about neuromuscular dysplasia of the ureter.

Prognosis of neuromuscular dysplasia of the ureter

The prognosis for recovery is relatively favorable. Even after the surgical intervention, one can not hope for a complete cure for pathology, since it is hidden, above all, in the dysfunction of the higher nervous structures.

The prognosis for life can be considered favorable only after proper and adequate treatment. In case of delay or wrong tactics, lethal cases can be documented.

The prognosis for operability is relatively favorable. If the pathology is complicated, patients may be recommended to change their place of work.

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