ureteral prolapse
Introduction
Introduction to ureteral prolapse Ureteral prolapse, also known as ureteral cyst, ureteral bulging, refers to the end of the ureter cystic bulging into the bladder, the outer layer of the bulging is the bladder mucosa, the middle is the thin layer of muscle and collagen tissue of the superficial layer of the triangle, the inner layer is Ureteral mucosa. The ureteral cyst can be opened in the bladder or ectopically opened at the bladder neck or distal end. basic knowledge The proportion of sickness: 0.00001% Susceptible people: no special people Mode of infection: non-infectious Complications: hydronephrosis
Cause
Causes of ureteral prolapse
(1) Causes of the disease
The embryological mechanism of the disease is still unclear, and there are several views:
1. Chwalle membrane delayed ulceration caused dilatation of the ureter and narrowing of the orifice.
2. The developing ureter delays the ureteral dilatation from the separation of the middle kidney tube.
3. The developing ureter has a segmental embryo stagnation at the distal end, which causes the distal ureter muscle to develop stagnation, resulting in a ureteral cyst.
(two) pathogenesis
1. Orthotopic ureter cyst: also known as simple ureter cyst (simple ureter cyst), more common in adults, the opening is normal or close to normal, while the cyst is completely in the bladder, small in situ The ureteral cyst produces only a slight ureteral obstruction and does not block the bladder neck. Therefore, the kidneys are often slightly or unaffected. Large orthotopic ureteral cysts account for most of the bladder, which can cause ureteral obstruction on one or both sides. It can block the bladder neck and cause urine retention. According to the literature, about 75% of large orthotopic ureteral cysts have double ureteral malformations.
2. ectopic ureter cyst (ectopic ureter cyst): more common in children than adults, about 75% of pediatric ureteral cysts belong to this type, Ericsson believes that any ectopic ureteral cysts extend into the urethra, and like some scholars, It is thought that it must be the ureter that occurs in the upper kidney segment of the ipsilateral repetitive kidney. Brock and Kaplan point out that ectopic ureteral cysts can occur in both ureteral malformations and in the absence of ureteral malformations, but their openings are ectopic. The cyst is generally large, and its opening may be normally round or cracked up to 1 cm, which may involve the bladder neck and the proximal urethra. Since the opening is above the external sphincter, it does not cause urinary incontinence.
Williams has a more detailed description of the ectopic ureteral cysts, which are divided into three types:
(1) The cyst is protruding in the neck of the bladder, and the base is relatively narrow. The cystography shows a semi-circular defect shadow. A urinary tract shows a mass extending to the posterior urethra, causing mild bladder neck obstruction, but does not directly affect Another opening of the ipsilateral double ureter.
(2) The cyst is located in the trigone of the bladder, with a wide base and extending to the posterior urethra. If the sacral ridge is in the midline of the posterior urethra, the ureteral opening is large, which may cause obstruction of the bladder neck and its juxtaposition of another ureteral opening due to cysts. More occupying most of the bladder triangle, so the cystoscope is not easy to see clearly, cystography shows a huge defect shadow above the bladder neck.
(3) is a second type of variation that forms a pocket on the posterior wall of the posterior urethra.
It must be pointed out that in some cases of ectopic ureteral cysts, the bladder wall of the posterior wall of the cyst is weak, which must be paid attention to during surgery and repaired at the same time.
3. Ureteral cyst prolapse: mostly complication of ectopic ureteral cyst, it can pass the bladder neck, the urethra is out of the urethra, mostly occurs in women, generally can reset itself, but can also occur incarceration and form a large A purplish red mass that protrudes from the urethra. This type must be differentiated from urethral mucosal prolapse.
4. Blind end type: due to the lack of end opening of the ureter, a cyst is formed, which is raised in the triangle of the bladder. At 3 months of the embryo, the kidney has begun to urinate, so this type of affected kidney must have been born at the time of birth. To severe damage.
Prevention
Ureteral prolapse prevention
The cause of this disease is not clear, and it is related to autosomal recessive inheritance. It is usually related to the marriage of a close relative, and the disease cannot 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 prolapse complications Complications hydronephrosis
Ureteral cyst with malformation or other complications: 1 normal side of the kidney and double ureter contralateral kidney; 2 side of the kidney with double ureter contralateral incontinence double ureter; 3 bilateral heavy renal ureter; 4 side of the kidney double ureter contralateral ectopic Ureteral orifice; 5 upper renal function on the affected side; 6 mild hydronephrosis on the affected side; 7 severely impaired renal function on the affected side; 8 abnormal renal development on the affected side with massive ureteral hydrops; The lateral renal function was severely impaired with the ipsilateral lower kidney and contralateral hydronephrosis; 10 the upper and lower kidney functions were severely impaired.
Symptom
Symptoms of ureteral prolapse Common symptoms Urinary dysfunction, urinary flow interruption, frequent urination, dysuria, poor urination, urgency, pain, renal artery obstruction, hematuria, ureteral cyst
1. Pain: Due to obstruction caused by ureteral cyst, ureter and hydronephrosis are gradually formed, and pain in the affected side may occur.
2. Urinary dysfunction: ureteral cyst can block the urethral opening, and even can be removed from the external urethra. The cyst tissue that is released is a red mucosal cyst, which can cause poor urination, interruption of urinary flow and urinary retention.
3. Urinary tract infection: easy to secondary urinary tract infection, frequent urination, urgency, urinary pain symptoms, and repeated attacks.
4. Stones: stones can be combined with cysts and renal colic and hematuria.
Examine
Ureteral prolapse examination
1. Urine routine: combined with urinary tract infections or stones, there are red blood cells, white blood cells.
2. Determination of urine osmotic pressure: impaired renal concentrating function can occur in the early stage of the disease.
3. Determination of renal function: serum creatinine and urea nitrogen are progressively elevated with the loss of renal compensatory function, and creatinine clearance is also a sensitive indicator.
4. Intravenous urography: 90% of ectopic ureteral cysts occur in the upper kidney of the double renal deformity. Due to poor renal function and no development, the lower half of the developed kidney is displaced outwards and downwards. There is a filling defect in the head of the sea snake; the side kidney function can also be understood.
5. Urinary bladder urography: 50% of ureteral cysts complicated with double ureter have ureteral reflux, occasionally male patients with prolapsed ureteral cysts easily confused with posterior urethral valve.
6. Bladder urethroscopic examination: to determine the size and opening of the cyst.
Diagnosis
Diagnosis and diagnosis of ureteral prolapse
diagnosis
Repeated urinary tract infections, children with dysuria should consider the possibility of this disease, especially girls with red suspicious urethral openings, should be highly suspected of this disease, combined with imaging and endoscopy to confirm the diagnosis.
Differential diagnosis
1. Bladder tumor: bladder tumor near the ureter can block or invade the ureteral orifice and cause upper urinary tract water. It can show filling defects during cystography, but the symptoms of bladder tumor are mainly gross hematuria; urine exfoliated cell examination Tumor cells can be found; B-ultrasound and CT examination show a solid mass in the bladder; cystoscopy can be seen in the bladder, papillary or solid neoplasms, biopsy can confirm the diagnosis.
2. Ureteral tumor: lower ureteral tumor often causes 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 defect; cystoscopy sometimes It can be seen that the ureteral orifice has prominent tumor tissue.
3. Bladder prolapse: more occurs in women, can see prominent dark red mass in the outer urethra, can cause ureteral obstruction, kidney, ureteral hydrops, cystoscopy can be seen bladder congestion and edema, no sac at the ureteral opening Sexual mass.
