ureteral valve
Introduction
Introduction of ureteral valve Congenital ureteral valve disease refers to a transverse mucosal fold protruding in the ureteral cavity, mostly within 3cm of the junction of the ureter and ureter, clinically divided into a ring valve (single or multiple annular valve), valvular valve (single or Three kinds of lobular valve and mixed valve (annular valve combined with valvular valve), causing proximal ureteral dilatation. basic knowledge Sickness ratio: 0.001%-0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: ureteral ectopic opening
Cause
Ureteral valve cause
(1) Causes of the disease
Congenital ureteral valve disease is unclear, although its pathogenesis has three doctrines, but it seems that "embryonic wrinkle residue theory" can better explain the formation of the upper ureteral annular valve and multiple annular valves; and "film formation" The doctrine can explain the formation of the lower ureteral valve, and the "abnormal ureteral embryogenesis theory" can explain the occurrence of other different types of ureteral valves.
(two) pathogenesis
At present, the mechanism of embryogenesis of ureteral valves remains unclear. There are three theories below.
1. The persistence of Chwalle membrane causes the Chwalle membrane to be an epithelial tissue membrane located in the lower end of the ureter. It appears as a normal marker of ureteral development at 6 weeks of gestation, but will rupture and degenerate at week 8 if only part A ruptured or unruptured will result in the formation of a ureteral valve.
2. Ostling's folds lead to pathological obstruction.
3. Abnormal ureteral embryogenesis.
Prevention
Ureteral valve prevention
The disease is a congenital disease, the clinical cause is not clear, and is related to autosomal recessive inheritance, usually associated with the marriage of a close relative, the disease can not be directly prevented. For patients with a family history of suspected chromosomal abnormalities, genetic screening should be carried out to avoid the offspring of the disease caused by chromosome inheritance after marriage. At the same time, attention should also be paid to strengthening nutrition during pregnancy, reasonable diet, and avoiding emotional stimuli that affect embryonic development.
Complication
Ureteral valve complications Complications of ureteral ectopic opening
About 50% of patients have recurrent ureters, ectopic ureteral openings, poor renal rotation, and horseshoe kidneys.
Symptom
Ureteral valve symptoms common symptoms ureteral dilatation urinary infection abdominal pain hematuria nausea
Often manifested as the affected side of the waist and abdominal pain, nausea, vomiting, urinary tract infection symptoms, such as bilateral lesions can occur renal insufficiency; often have hematuria in colic and calculus; combined with hydronephrosis can be in the waist and abdomen There is a sexy mass of sac.
Wall and Wachter present the characteristics of the ureteral valve from an anatomical point of view and use it as a basis for diagnosis:
1. The ureteral mucosa has transverse wrinkles and contains smooth muscle fiber bundles.
2. The ureteral dilatation above the valve, the following is normal.
3. No other mechanical or functional obstructive factors exist.
Examine
Ureteral valve examination
1. Urine routine examination combined with infection and stones in the urine have red blood cells and pus cells.
2. When renal insufficiency, blood biochemical examination of urea nitrogen, creatinine increased.
The typical X-ray findings of intravenous urography (IVU) and retrograde pyelography (RGP) are as follows: 1 ureteral lumen parallel to the renal pelvic wall, forming a "high-level embedded obstruction"; 2 cone-shaped or lobes produced by a side wall of the ureter The filling defect is embedded in the ureteral cavity of the stenosis segment; 3 the opposite side walls of each ureter have a filling defect embedded in the lumen, which becomes a pair of interlocking flaps. Retrograde angiography shows an inverted "V" shape change in the lesion.
Diagnosis
Diagnosis and differentiation of ureteral valve
General surgical routine examination, intravenous urography, CT examination, cystoscopy and retrograde angiography, urinary bladder urography is helpful for diagnosis, but most patients are clearly diagnosed in surgical exploration.
Differential diagnosis
1. Ureteroscopic tumors of the lower ureteral tumor often cause kidney, ureteral hydrops, renal dysfunction, but mostly with gross hematuria as the main clinical manifestations; urine exfoliated cell examination can find tumor cells; IVU shows lower ureteral filling defects; cystoscopy is sometimes visible Tumor tissue is prominent in the ureteral orifice.
2. Ureteral calculi Lower ureteral stones can cause kidney, ureteral hydrops, secondary infections can have fever, frequent urination, urgency and dysuria, patients may have a history of renal colic, pain accompanied by microscopic or gross hematuria, KUB The opaque shadow of the ureteral path can be seen on the plain film. The urinary tract angiography shows the obstruction of the calculus, the upper ureter and the hydronephrosis of the obstruction, and the negative stones can be found by B-ultrasound and CT examination.
3. Ureteral cysts Ureteral cysts are cystic dilatation at the ureteral opening, small opening, poor urination, can cause ureteral dilatation, the extent of expansion is lower in the lower segment, the ureteral dilatation in the whole process, B-ultrasound shows a circle in the bladder Cystic vesicles, cystic fluorosis showed a circular filling defect in the bladder. Cystoscopy showed a round tumor of the ureteral orifice. The surface was smooth, and a small round hole was intermittently irrigated. The size of the cyst changed with urination.
4. Ureteral stenosis can cause hydronephrosis, the history of the ureteral stenosis can be consulted, urography can be found in ureteral stricture and above ureteral dilatation and hydronephrosis.
