ureteral stricture
Introduction
Introduction There are three physiological curvatures of the ureter, which is the stenosis. The first stenosis is penetrated into the bladder wall; the second stenosis is inserted across the radial artery into the small pelvis; the third stenosis is penetrated into the bladder wall. Ureteral stenosis refers to the ureteral lumen or the whole segment is narrower than normal due to various reasons. Although the continuity of the lumen is not interrupted, it has caused different degrees of upper urinary tract obstruction and hydronephrosis.
Cause
Cause
In addition to congenital causes, inflammation, injury and surgical scarring are the main causes. The ureteral orifice is narrowed, and the stenosis is more complete. There is a side of low back pain. Sometimes the kidney that touches the stagnant water has a chilly fever or bile ureteral stenosis. The uremia is the result. The closer to the kidney, the earlier the damage to the kidney occurs. The degree is also heavier. Eventually it will lead to loss of kidney function. In order to protect kidney function from damage, drugs with greater nephrotoxicity are prohibited or used with caution.
Examine
an examination
Related inspection
Ureteroscopy, intravenous urography, retrograde pyelography
Back pain, waist swelling and urinary, abdominal, pelvic surgery history, should suggest that the disease may be, B-ultrasound can be found in varying degrees of hydronephrosis, excretory urography and retrograde pyelography can help diagnose. If necessary, pyelography or retrograde angiography can clearly identify the location, extent, and length of the obstruction.
1. History of pelvic or ureteral surgery.
2. Low back pain, cystic mass in the upper abdomen.
3. B-ultrasound: ureteral dilatation above the stenosis, hydronephrosis.
4. The isotope kidney map is an obstructive kidney map.
5. Intravenous pyelography (IVP) shows the degree of hydronephrosis, the site of stenosis.
6. Ureteral retrograde intubation angiography can confirm the diagnosis.
Diagnosis
Differential diagnosis
The diagnosis should be differentiated from other symptoms of the ureter:
1. Cancerous ureteral stricture The ureteral tumor can be divided into benign and malignant according to the nature of the tumor. Benign ureteral tumors such as polyps, malignant tumors such as transitional cell carcinoma, transitional cells with squamous cell carcinoma, mucinous carcinoma, etc.
Ureteral tumors are rare in clinical practice. The age of onset is 20 to 90 years old, and men are more than women, about 4:1. Primary ureteral tumors originate in the ureter itself, with malignant tumors, most of which (90%) are transitional cell carcinomas.
2. Ureteral obstruction The ureteropelvic junction obstruction is a common urinary tract obstruction that causes hydronephrosis. Because the obstruction of the ureteropelvic junction obstructs the smooth discharge of renal pelvis into the ureter, the renal pelvis emptying disorder causes the renal system to expand. At first, the smooth muscle of the renal pelvis gradually proliferates, strengthens the peristalsis, and attempts to discharge the urine through the distal obstruction; when the increasing amount of creeping power cannot overcome the obstruction, it will lead to atrophy of the renal parenchyma and impaired renal function.
3. Ureteral cyst ureteral cyst: cystic dilatation of the end of the ureter. During the embryonic development, the septum between the ureter and the urogenital sinus does not absorb and resolve, forming different degrees of stenosis of the ureteral orifice, or the fibrous structure at the end of the ureter is weak or the path between the wall is too long, and the curve is caused by the urinary flow. After the formation of a cystic dilation into the bladder. Early cases are clinically asymptomatic and are often found in the diagnosis of severe renal deformities. Symptoms are mainly urinary tract obstruction, causing repeated urinary tract infections. Due to the small opening of the cyst, persistent obstruction of the ureteral orifice can lead to ureter and hydronephrosis, loss of renal function, cystic occlusion of the bladder neck, dysuria or interruption of urinary flow, and recurrent urinary tract infection. Sometimes girls cysts can be removed from the urethra through the bladder neck and urethra, and can usually be reset by themselves. However, an incarcerated purple mass can also occur. The principle of treatment is to relieve obstruction, prevent reflux, and deal with complications. If the upper half of the affected side is dysfunctional, it can be used for partial nephrectomy. About 20 to 25% of cases still have symptoms after surgery, and the cysts are treated again. If the kidney function is good, it can be used for ureteral cyst resection and anti-reflux ureteral bladder replantation.
