ureter after inferior vena cava
Introduction
Introduction to the inferior vena cava ureter The inferior vena cava ureter, also known as the perivascular ureter, is a congenital malformation of the abnormal development of the inferior vena cava. The main pathological change of this disease is caused by obstruction. Due to the obstruction of ureteral pressure, the drainage of urine is not smooth, resulting in dull pain or even colic in the waist or abdomen. Hematuria is one of the common symptoms, and some patients are accompanied by urinary stones. Although the inferior vena cava ureter is a congenital malformation, most patients develop symptoms only after adulthood. basic knowledge The proportion of illness: 0.002% - 0.004% Susceptible people: no specific population Mode of infection: non-infectious Complications: hydronephrosis
Cause
Cause of ureter after inferior vena cava
(1) Causes of the disease
After the embryonic period, the main vein, the lower main vein and the upper main vein 3 pairs of veins agree with each other to form a vein ring on both sides. At 12 weeks of embryo, the posterior kidney rises from the pelvis and crosses the ring to the waist. Therefore, the ring is also called kidney. The ureter passes through the ring; when the main vein shrinks, the blood circulation is carried by the lower main vein and its branches, and the inferior vena cava is formed behind the renal ring, so the position of the ureter should be in front of the inferior vena cava, if the posterior main vein is not Atrophy, instead of the part behind the kidney ring, the front of the kidney ring becomes the inferior vena cava, so that the ureter is located behind the inferior vena cava; if the ventral side of the venous ring does not disappear, because there is a right lower main vein on the dorsal side and The ventral side forms a double inferior vena cava, resulting in a right ureter between the inferior vena cava.
(two) pathogenesis
The actual malformation of the disease is mainly due to abnormal development of the inferior vena cava, rather than abnormal ureteral dysplasia.
The typical case is that the right ureter bypasses the vena cava and then goes to the midline, and then from the inside to the outside along the normal path to the bladder, the renal pelvis and the upper ureter dilate, but generally no obstruction, Bateson et al (1969) divided the inferior vena cava ureter into 2 Clinical type: type I, with hydronephrosis and obstruction, obstruction proximal ureter is fish hook-like, more common; type II, no hydronephrosis or only mild hydronephrosis, this type of ureter is moving toward a higher position After the vena cava, the renal pelvis and ureter are almost horizontal, no distortion, if the obstruction is caused by the compression of the ureter located in the side wall of the vena cava by the paravertebral tissue, the type I obstruction is at the iliac crest muscle, the point is the ureter First to the head side, then to the vena cava.
Prevention
Inferior vena cava ureter prevention
The disease is a congenital disease and there are no effective preventive measures.
Complication
Inferior vena cava ureteral complications Complications hydronephrosis
Some cases combined with horseshoe kidney, left kidney deformity such as kidney development, hydronephrosis, insufficiency and hypoplasia.
Symptom
Ureteral symptoms after inferior vena cava Common symptoms Inadequate urination, dull pain, hematuria
The main pathological change of this disease is caused by obstruction. Due to the obstruction of ureteral pressure, the drainage of urine is not smooth, resulting in dull pain or even colic in the waist or abdomen. Hematuria is one of the common symptoms, and some patients are accompanied by urinary stones. Although the inferior vena cava ureter is a congenital malformation, most patients develop symptoms only after adulthood.
Examine
Examination of the ureter after inferior vena cava
The diagnosis mainly relies on intravenous urography and retrograde ureteral intubation, showing ureteral displacement, which forms a sickle-shaped or "S" deformity across the 3rd and 4th lumbar vertebrae in the median line, and the ureter is expanded in the proximal segment of the compression. Renal hydronephrosis, Randell pointed out that in the X-ray oblique position, there is a certain distance between the normal ureter and the lumbar vertebrae, but the ureter after the inferior vena cava is close to the lumbar vertebrae. If the above examination method still fails to obtain a clear conclusion, The examination method proposed by Presman and Firfer can be used, that is, after the right ureter is intubated, an X-ray-free catheter is inserted into the saphenous vein of the thigh to the inferior vena cava, and then X-rays are taken to display The relationship between the right ureter and the inferior vena cava, ultrasound, CT and MRI are valuable for the diagnosis of vascular malformations.
Diagnosis
Diagnosis and diagnosis of ureter after inferior vena cava
diagnosis
The clinical manifestations of this disease are atypical. About 25% of cases have no significant symptoms or only mild and tolerable low back pain. The diagnosis depends on intravenous urography and ureteral retrograde angiography.
Differential diagnosis
Renal tumor
When the large right kidney tumor pushes the ureter to the midline, it should be differentiated from the posterior vena cava ureter. The kidney tumor has a history of gross hematuria. When the tumor is large enough to move the ureter to the medial side, it should be able to be in the abdomen. Touching the mass; B-ultrasound and CT examination can determine the relationship and size of the tumor with the kidney; urography can show that the renal pelvis and renal pelvis are deformed or completely disappeared.
2. Right ureteral calculi
Right ureteral calculi can cause hydronephrosis in the right kidney, but there are many paroxysmal right renal colic with hematuria. Urinary angiography can detect calculi in the ureter, and the ureter and renal pelvis expand above the stone.
3. Right ureteral stricture
Can cause hydronephrosis, the history of the ureteral stenosis can be asked, urography can be found in ureteral stricture and above ureteral dilatation and hydronephrosis.
4. Primary giant ureter
There may be kidney, ureteral hydrops, urography to show ureteral tortuosity, but not to the midline shift, no "S" shape change, ureteral near the bladder opening is narrow, the end is spindle-shaped.
