Urethrocele

Description:

Ureterotsele is an inborn cystous expansion of submucosal department of the ureter eminating in a bladder cavity.
Meet to an ureterotsela of both solitary (only thing), and the doubled ureter. In the latter case it is always connected with an ureter of an upper segment of a kidney.

  At full doubling of a kidney in some cases there is pathology of an ureter of the lower segment - puzyrno an ureteric reflux, t. е unnatural throwing of urine from a bladder in an ureter or гидроуретеронефроз, i.e. the disturbance of outflow of urine from an ureter connected with obstruction of its output department. Both of these states aggravate the existing problem (each of them also leads to pyelonephritis and an atrophy of renal fabric) and assume difficult versions of its decision.

Urethrocele symptoms:

Occasionally there are complaints to the complicated urinations connected with obstruction to an ureterotsela of an internal opening of an urethra, an abdominal pain or in lumbar area to the party of defeat. But most often pathology 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 analyses of urine the quantity of leukocytes increases, protein appears. In blood tests 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.

Urethrocele reasons:

In most cases pathology is caused by narrowing of the mouth of an ureter that leads to disturbance of outflow of urine from an ureter, to restretching of the last, increase in pressure in pyelocaliceal system of a kidney. Supertension and stagnation of urine in a renal pelvis lead to disturbance of blood supply and development of a microbic inflammation of renal fabric (pyelonephritis) that causes a so-called nephrosclerosis (substitution of normal renal fabric hems). Owing to a nephrosclerosis the kidney loses the main functions.

Treatment of the Urethrocele:

So far in the majority of the Russian hospitals at treatment of children with the ureterotsel generally band surgical interventions are used. The type of operation depends on a functional condition of a kidney. In the absence of function of a kidney or a segment of a kidney carry out organounosyashchy operations. At a solitary ureter a nephrectomy (removal of a kidney), at doubled - an upper geminefrureterektomiya (removal of an upper segment of a kidney with an ureter) and excision to an ureterotsela. As the doubled ureters in prevesical department often have the general wall, it is also necessary to replace and an ureter of the lower segment of a kidney. At safe function of a kidney (segment) to an ureterotsela it is excised and the plastic interventions directed to recovery of a passage of urine and prevention of a vesicoureteral reflux are made.

  Shortcomings of surgical interventions are well-known: high injury, need for the long combined anesthesia. For free outflow of urine in the postoperative period uric ways have to be without fail temporarily trained by tubes which are brought to skin. Children spend the first days after operation in intensive care units as they need an intensive care and narcotic anesthesia. Duration even of the uncomplicated hospital period after band operation makes depending on the nature of the postponed intervention from 14 to 30 days. It is necessary to consider also a possibility of early and late postoperative complications, such as bleeding, an exacerbation of pyelonephritis, cicatricial narrowing of an anastomosis (places of sewing together of ureters among themselves or with a bladder), emergence of vesicoureteral refluxes.