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Megaureter: overview of information
Last reviewed: 23.04.2024
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Megoureter is a collective term that reflects the state of the expressed expansion of the ureter and ChLS.
For the first time, the term "megourareter" was proposed by Caulk in 1923. Subsequently, various authors, introducing and emphasizing their understanding of the individual causes and varieties of the megaureter, offered many other names: atonic, dilated, giant, cystic, idiopathic ureter, urological Hirschsprung, ureteral achalasia, obstruction ureter, hydroureter, hydroureteronephrosis, megaloureter, megadolichoureter, segmental dysplasia of the periapyrus of the ureter, neuromuscular dysplasia of the ureter, etc.
Whatever the anomaly of ureter development, there are definitely only two types of consequences of neuromuscular dysplasia (the megoureter is obstructive, as a consequence of congenital stenosis of the ureteral orifice, and refluxing as a result of underdevelopment of the closure in the ureter's anastomosis).
Epidemiology
According to NA. Lopatkina (1971). The prevalence of a megaureter as an anomaly of development is 7: 1000 patients with diseases of the urinary system. Among boys and girls, the prevalence of the disease is approximately the same, but the obstructive form of the mega -ureter is more often detected in boys. In 10-20% of cases, the megoureter is two-way. With a one-way megaoureter, it's difficult to identify the most frequently affected side. Literary data on this issue are extremely contradictory. According to NA. Lopatkina. The right ureter is most often affected.
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Causes of the megaprofessional
Megaureter is always a consequence of an abnormality in the development of the urinary tract.
Often, the megaureter is combined with other abnormalities of the urinary system: agranesis of the contralateral kidney, polycystic kidney dysplasia, simple kidney cysts, doubling of the kidneys, ureterocele. When the IMP is doubled, the most typical changes are revealed from the side of the urinary tract of the upper hypoplastic half of the doubled kidney, which is associated with ectopia and stenosis of the ureteral orifice.
Symptoms of the megaprofessional
Symptoms of the megaureter are diverse. The most typical symptom of a megaureter is biphasic urination (shortly after urination, the urinary bladder rapidly replenishes with urine from the expanded VMP, which in turn leads to the need to empty the bladder again). Often the second portion of urine exceeds the first by the volume because of the large amount of urine that accumulates in the pathologically altered upper parts of the urinary tract. For the second portion of urine is also typical the presence of turbid sediment and fetid odor.
Nonspecific symptoms of a mega -ureter are physical retardation, asthenic syndrome, sometimes subfebrile fever, nausea, dysuria, pain in the abdomen or lower back.
Diagnostics of the megaprofessional
Modern possibilities in the diagnosis of this anomaly are extensive. The first diagnostic signs of the disease can be detected even before the birth of the child.
Nonspecific manifestation of the disease - palpable through the anterior abdominal wall volumetric formation.
In the general analysis of urine, leukocyturia and bacteriuria are identified, which can sometimes be the only manifestations of the disease. In the general analysis of blood, signs of the inflammatory process (leukocytosis, anemia, increased ESR) are revealed. In the biochemical analysis of blood, special attention should be paid to the level of urea, creatinine and the total protein of blood serum, which is especially important in the bilateral process, since for such patients the manifestations of chronic renal failure come to the fore.
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Treatment of the megaprofessional
Treatment megouretera is always operative (with the exception of the vesicular-dependent forms of the disease). In cases where the cause of the disease is ureterocele, occlusal stone of the distal ureter or some other obstruction to urinary outflow, surgical treatment should be aimed at its elimination, and if necessary combined with correction of the ureter and antireflux plasty of the mouth.
The basis for the principles of surgical treatment of neuromuscular dysplasia is the idea of restoring the normal passage of urine through the ureter in combination with the prevention of vesicoureteral reflux. For this purpose, various variants of reimplantation of the ureter (ureterocystoanastomosis) and ureter reconstruction during its widened part are used.