Ureterotsele – the defect of a mochetochnik which is characterized by cystous expansion of its disteel department and a vybukhaniye in a bladder cavity. Ureterotsele is followed by waist pain, dizurichesky frustration, gematuriy. Diagnostics to an ureterotsela includes performing ultrasonography of a bladder and kidneys, excretory urography, a tsistografiya, a tsistoskopiya. Treatment consists in a section of the narrowed mouth of a mochetochnik and removal to an ureterotsela with the subsequent mochetochnikovy reanastomoz; in certain cases performance of a partial or total nefrektomiya is required.
Ureterotsele is a vnutripuzyrny (ureterovezikalny) cyst of disteel department of a mochetochnik. At the ureterotsel kistovidno the expanded vnutripuzyrny segment of a mochetochnik prolabirut in a bladder cavity. In urology to an ureterotsela meets frequency of 2 - 2,5%; at the same time at girls it is observed by 2-4 times more often than at boys. Usually to an ureterotsela it is diagnosed already at children's age, is more rare – at adults. Ureterotsele often is followed by doubling of mochetochnik.Please Help us - click on the advertisement
Classification to an ureterotsela
Ureterotsele can be unilateral or bilateral (bilateral), located in both mochetochnik. Distinguish to an ureterotsela simple (in normally located mochetochnik), prolabiruyushchy and ektopichesky. Prolabiruyushchy (dropping out) to an ureterotsela at girls can come through an urethra to light in the form of formation of the dark-purple color which is often covered with an izjyazvlenny mucous membrane. The Prolabiruyushchy ureterovezikalny cyst at boys drops out in pro-static department of an urethra, causing a sharp delay of an urination. Ektopicheskoye to an ureterotsela is localized in atypically located mochetochnik opening in an urethra, a vagina threshold, a bladder diverticulum etc. Sometimes meets blindly coming to an end to an ureterotsela.
On an etiology to an ureterotsela can be primary (congenital) or secondary (acquired). Allocate 3 degrees congenital to an ureterotsela. At 1 degree there is an insignificant expansion of vnutripuzyrny department of a mochetochnik which is not bringing to functional changes of the top uric ways. Ureterotsele 2 degrees has the big sizes and leads to development of an ureterogidronefroz. At the ureterotsel 3 degrees, except an ureterogidronefroz, arise considerable violations function of a bladder.Please Help us - click on the advertisement
Reasons for an ureterotsela
In most cases to an ureterotsela is caused by the congenital narrowing of the mouth of a mochetochnik and lengthening of its intramuralny segment caused by deficiency of muscle fibers in disteel department of a mochetochnik. According to researchers, this defect is connected with violation of an innervation of the lower departments of a mochetochnik and adjacent fabrics. Acquired to an ureterotsela more often develops owing to infringement of an uric stone in an intramuralny segment of a mochetochnik.
Ureterotsele is always followed by violation of outflow of urine from a mochetochnik, increase in hydrostatic pressure, restretching of a wall of a mochetochnik and its vybukhaniye in vnutripuzyrny department uric . The cavity to an ureterotsela is limited to walls of a mochetochnik and the stratified bladder wall. Usually the ureterotsel contains purulent urine, concrements; more rare – watery or bloody contents.
Violation of process of urination results in stagnation of urine in a kidney lokhanka (gidronefroz), microbic infection, development of cystitis and pyelonephritis, formation of uric stones in the ureterotsel, and in the subsequent – to nephrosclerosis and loss of function of a kidney.Please Help us - click on the advertisement
Symptoms to an ureterotsela
As the main manifestations to an ureterotsela serve the pain syndrome and violation of character of an urination. Ureterotsele of large volume can occupy a considerable part of a bladder and limit its volume, being followed by increase of an urination and release of urine small portions. In case of overlapping by such protrusion of the mouth of other mochetochnik, total violation of outflow of urine from kidneys – sharp , shown pristupoobrazny pains as renal colic develops. At women at omission to an ureterotsela in an urethra development of a full delay of urine is possible.
Complication to an ureterotsela women can have its prolapse with an exit outside in attempt of an urination. Loss to an ureterotsela has intermittiruyushchy character and is set independently. In certain cases dropped out to an ureterotsela it can be restrained in an urethra and nekrotizirovatsya.
More often to an ureterotsela it is characterized by the constant aching waist pains and podvzdoshny area, constant recurrent infections (chronic cystitis and pyelonephritis), a piuriya, fever, a painful urination with badly the smelling urine, sometimes a gematuriya.Please Help us - click on the advertisement
Diagnostics to an ureterotsela
Ureterotsele usually comes to light during expanded urological inspection concerning recurrent infections of uric ways. In the general analyses of urine at the ureterotsel leukocytes, pus, erythrocytes, as a rule, are found. The bacteriological research of urine reveals microflora, characteristic of uric infections.
Ultrasonography of a bladder allows to visualize to an ureterotsela in the form of roundish thin-walled liquid education, vybukhayushchy on a bladder wall. At ultrasonography of kidneys one is found - or bilateral hydronephrotic transformation of body.
By means of beam researches (the tsistografiya and excretory urography) manage to receive a clear radiological picture to an ureterotsela. Existence of a puzyrno-mochetochnikovy reflux in adjacent and an opposite mochetochnik, defect of filling of a bladder, club-shaped expansion (sometimes an ektopiya) a disteel segment of a mochetochnik is determined by roentgenograms. Reliable identification to an ureterotsela is also examined during a tsistoskopiya. At endoscopic survey to an ureterotsela has an appearance of kistoobrazny protrusion of a vnutripuzyrny part of a mochetochnik with the narrowed mouth.Please Help us - click on the advertisement
Treatment to an ureterotsela
Treatment to an ureterotsela can be only surgical – reconstructive or oranoudalyayushchy. Before operation the antimicrobic therapy directed to knocking over of an infection of uric ways is carried out. At a nonfunctioning kidney or its part the nefrektomiya or a partial nefrektomiya with excision is shown to an ureterotsela and a reimplantation of the top segment of a mochetochnik in a lokhanka, and lower - in a bladder ().
At safe functions of a kidney make an endoscopic section to an ureterotsela with formation of the mouth of a mochetochnik by an anti-reflux technique. The transurethral endoscopic section of the mouth leads only to elimination of obstruction of a mochetochnik, but does not eliminate to an ureterotsela. Complications of surgical treatment to an ureterotsela are, as a rule, connected with development of a puzyrno-mochetochnikovy reflux, bleeding, an exacerbation of pyelonephritis, cicatricial narrowing of anastomoz.