Megaureter

Description:

In children's practice a megaureter – one problems leading to renal complications. First, stagnation of urine in an ureter and a renal pelvis does not provide adequate evacuation of the microbic flora getting into uric ways which causes a chronic inflammation of kidneys (pyelonephritis). Secondly, pathological impact on a renal blood stream puts supertension in a renal pelvis. An outcome of a chronic inflammation and disturbance of renal blood circulation is scarring of renal fabric with function loss (a secondary granular kidney, a nephrosclerosis).

Megaureter's symptoms:

Occasionally there are complaints to abdominal pains or in lumbar area to the party of defeat. But most often in the absence of pathology of a bladder and an urethra the megaureter does not prove clinically before development of pyelonephritis. The last has a characteristic clinical laboratory picture, well-known to pediatricians. In an acute phase of a disease high temperature, intoxication symptoms is noted. In urine the quantity of leukocytes increases, protein appears. In blood the increased level of leukocytes, the increased SOE is also defined. As a rule, pediatricians direct children with acute pyelonephritis to hospitalization after which examination on an urological profile is usually conducted.

Megaureter's reasons:

There are 2 main forms of a megaureter. Primary – inborn disturbance of ultrastructure of a wall of an ureter which consists in an imbalance between muscular and connecting tissue. At the same time an ureter so "sluggish" that is not able "to push" urine through output department most of which often has normal diameter. Secondary results from the supertension in a bladder caused by disturbance of its emptying (functional, as a result of various options of dysfunction of a bladder, or organic, connected with an obstacle in an urethra).

Megaureter's treatment:

At primary megaureter the surgical interventions directed to creation of a new anastomosis between a bladder and an ureter (ureter reimplantation to a bladder), rather wide that the "sluggish" ureter could be emptied easily are carried out, but at the same time avoid the return current of urine.

The essence of operations consists in the following. Rather narrow output department of an ureter is exsected. Between a mucous and muscular coat of a bladder the wide tunnel to which the end of the rest of an ureter is spent is created and the new, wide mouth which is not interfering an urine effluence forms. When filling a bladder the elastic upper wall of an ureter nestles to lower, lying on quite dense muscular layer of a bladder that provides valve anti-reflux function.

At the expressed megaloureter its longitudinal zauzhivaniye is made for increase in efficiency of intervention.

During intervention uric ways have to be without fail trained by tubes. It provides favorable conditions for healing of internal seams, prevention of uric fistulas and an exacerbation of pyelonephritis in the early postoperative period. Uric drainages are removed on the 12th – the 21st days of the postoperative period depending on degree of a megaureter and features of surgical intervention.

In certain cases, it is preferential at children aged till 1 year, discrepancy of the sizes of a huge ureter and a normal bladder does not allow to execute ureter reimplantation. To these patients stage treatment is carried out. The first stage imposes an ureterokutaneostoma (the ureter in a middle part is brought to skin). Free outflow of urine from a kidney is provided that favorably affects its function and serves as prevention of exacerbations of pyelonephritis. Besides, the "unloaded" ureter is gradually reduced that allows to carry out the second stage of treatment - its reimplantation. After registration of a positive take of reimplantation of an ureter the 3rd phase of treatment - closing of an ureterokutaneostoma is completed.

The secondary megaureter is a complication of pathology of a bladder and an urethra. Outflow of urine from ureters is recovered after elimination of pathology of the lower uric ways.