Diagnostics megouretera

Diagnostics megaureter is carried out immediately after birth. It is performed with the help of ultrasound (they reveal the enlargement of the renal pelvis by more than 1.0 cm with the thinning of the parenchyma of the organ to 0.5 cm, the ureter enlargement by more than 0.7 cm). Ultrasound with color Doppler mapping makes it possible to assess the degree of decrease in renal blood flow.

UFM allows to determine the type of urination (obstructive / non-obstructive), exclude IBO, to suspect neurogenic dysfunction of the bladder.

[1], [2], [3]

X-ray diagnostic megaureter

These research methods allow to establish the main cause of the disease and determine the stage of the megaureter.

• Survey urography. During the study, anomalies of the spine (partial incision of vertebral arches, sacralization of the sacrum and coccyx, diastematomyelia), which are considered manifestations of myelodysplasia, are often detected. They are often combined with the defects of the genitourinary system.
• Excretory urography is a routine study performed with non-ionic iodine-containing contrast agents (yogexol, yopomide, etc.). Pictures are taken in a straight, lateral (1/4) projection, in a wedge and orthostatic position. Excretory urography allows to determine:
  • excretory capacity of the kidneys (symmetry, lagging of the excretory function of one of them);
  • anatomy of the organ [location and shape of the kidneys, doubling of the VMP, the structure of the cup-and-pelvis system, the state of the renal parenchyma (early nephrograms allow to judge the presence of sclerosis zones of the parenchyma)];
  • expansion of the cup-and-pelvis system;
  • passage of the contrast medium along the ureter;
  • the entry of a contrast agent into the bladder;
  • features of the contrast agent from the bowel-and-pelvis system and the ureter (including PMS passability), the presence of achalasia, which is not visible with a complete bladder.

If obstruction is detected at the level of the vesicoureteral anastomosis with the development of achalasia / megaureter / hydroureteronephrosis, delayed urograms (after 120 and 180 min) are made to obtain data on the time of contrast agent isolation.

Cystography

It is performed to determine the anatomical state of the lower parts of the urinary tract, and also to exclude PMR. For research it is necessary to use warm solutions with radiopaque preparation and urethral catheters of Nelaton or Foley No. 6-14 SN. The volume of fluid slowly introduced into the bladder by its preliminary retrograde catheterization should correspond to the physiological norm.

Formulas for the calculation of fluid volume:

30 + 30 х age of the child in years (for children of preschool age); 146 + 6.1 x the age of the child in years (for children of school age) - the formula of Tischer.

Perform two shots: in a direct projection with a filled bladder and in 1/4 (lateral projection) during the act of urination (after removal of the urethral catheter).

According to the International classification of DMR, five degrees of reflux are distinguished. The megourareter is characterized by refluxes of degree IV (reflux into the enlarged ureter and cup-and-pelvis system with dilatation of the calyx necks and smoothing of the fornix arches) and degree V (reflux into the sharply expanded convoluted ureter and sharply widened cup-and-pelvic system as terminal hydronephrosis).

Radioisotope diagnostics of a megaureter is performed to assess the structural and functional state of the kidneys. The method has a number of significant advantages over excretory urography and ultrasound. Which is associated with a lower radiation load (in comparison with urography), a clearer image and the possibility of earlier diagnosis of structural changes in the parenchyma.

As the RFP, glomerulotropic Tc-pentatech • (calcium trisodium pentate) (GFR definition) and tubulotropic sodium iodiphippate (assessment of renal plasma flow) are mainly used. Scanning is performed on gamma cameras. This mega -ureter diagnostics is performed after the bolus intravenous injection of the isotope at doses corresponding to 1 mCI per 1 kg of body weight (age from 1 year to 7 years) and 2-3 mSl per 1 kg (age 7 years and over). The radial load on critical organs, taking into account the features of the isotope, ranges from 0.2 to 2.0 mSv. The subsequent computer processing of data allows to judge the location, size and contours of the kidneys, the features and time of accumulation of RFP in the renal parenchyma (evaluation of the structure), the time and symmetry of excretion of the drug, its progression along the VMP with an assessment of their anatomical features, which, in turn, allows quantify and calculate the deficiency of the functional capacity of the kidneys.

Diagnostics megaureter is relatively simple, if the patient is suspected of a disease of the organs of the urinary system. In cases where the kidney function is preserved, on the excretory urogram with bilateral disease, sharply enlarged convoluted ureters are seen with a relatively small pelvis. When the function of the kidneys is reduced, delayed pictures or infusion urography should be performed.

Lessons of neurological diagnostics of a megaureater make it possible to clarify the stage of this disease of the genitourinary system and assess the functional capabilities of the affected ureter. L.N. Lopatkina (1974), using the lessons of neurology, found that with achalasia, the contraction wave reaches the lower cyst and does not spread further. With megaloureterohydronephrosis, the contractile waves are very rare or absent altogether. Ureteronephrosis transformation inevitably leads to the development of chronic renal failure.