The constriction of the ureter leads to a retention of urine in the kidney and part of the ureter. It is a very dangerous condition that can lead to numerous urinary tract infections, the formation of kidney stones and, in the worst case, to kidney failure. What are the causes and symptoms of ureteral stricture? What is the treatment of this ailment?

Ureteral stricture( ureteral stricture ) is a ureteral defect that leads to urine stagnation above the stricture. The kidney produces the right amount of urine, but there is an obstruction in the outflow path that prevents urine from flowing into the bladder through the ureter.

Urine remains in the kidney, which leads to an increase in intrarenal pressure, and consequently to progressive destruction of the renal parenchyma and their failure. Professionally, this process is calledhydronephrosis . Complication of urinary retention may be not only kidney failure, but also the formation of kidney stones, which intensify the process of kidney destruction, and numerous urinary tract infections.

Ureteral stricture - causes

Ureteral stricture may be a birth defect in the smooth muscle of the ureteral wall. It can also be caused by abnormal vascularization (additional vessels cross the ureter), connective tissue adhesions that compress the ureter, and adhesions of the ureter with the pelvis or lower pole of the kidney. Also, excessive kidney mobility may be the cause of the disease, because as it lowers, it causes the ureter to bend.

The cause of the obstructed outflow of urine from the kidney may also be prostate hyperplasia, a tumor (prostate cancer, uterine cancer, ovarian cancer, colorectal cancer), urinary stone, polyp or mass pressing the urinary tract from the outside, as well as vesic reflux - ureteral.

Ureteral stricture can also be a complication of cystectomy (Braser method of surgical removal of the bladder to form an intestinal bladder) or after kidney transplantation.

Damage to the ureter, resulting in stricture, can also occur accidentally during urinary tract surgery or procedures. Then there is talk of iatrogenic ureteral damage.

Ureteral constriction - symptoms

When hydronephrosis occurs in only one kidney, the following appear:

  • pain in the lumbar region - it can be periodic and described as dull, or it can appear in the form of acute pain attacks that radiate into the groin;
  • protruding epigastric integuments (you can also feel a soft, painless tumor in this area);
  • nausea and vomiting;
  • positive Goldflam symptom - when the doctor hits the lumbar region of the patient's back, the patient experiences severe pain, which indicates an acute inflammatory process of the kidney on the examined side;

When hydronephrosis occurs in both kidneys, the patient may complain of:

  • lack of appetite;
  • weight gain;
  • swelling of both lower limbs;
  • weakness and nausea;

There may also be hematuria and hypertension.

Important

Ureteral constriction - when to see a doctor immediately?

When a patient develops an acute pain attack (ie one that occurs shortly), which is accompanied by chills and fever, seek medical attention as soon as possible. This is becauseurosepsy( ureteral sepsis ) - the most severe form of urinary tract infection.

Ureteral stricture - diagnosis

If ureteral stricture is suspected, the primary test isintravenous urography.This is a contrast X-ray examination performed to assess the function of the kidneys and the location and structure of the urinary tract. You can also performdiuretic renoscintigraphy . This is a test similar to urogfaria, except that an isotope is administered intravenously instead of a contrast medium. In addition, an ultrasound examination is performed, which allows you to assess the shape and size of the kidneys. During the ultrasound examination, the so-calleddiuretic testcan be performed. It is based on the intravenous administration of furosemide, followed by observation of the degree of dilation of the urinary tract and measuring the time to return to normal size. In addition, computed tomography and magnetic resonance imaging can be performed.

When the doctor is unable to make a definitive diagnosis based on the above-mentioned examination, may decide to perform numerous radiographic examinations using contrast:replacement pyography ,ascending pyographyandmicturition cystourethrography.Another test, but rarely done, is theWhitaker Test , which involves inserting pressure sensors into the pelvis and bladder and measuring the differential pressure.

Ureteral stricture - treatment

Usually, an operation is required to remove the obstruction in the drainurine. An alternative ispercutaneous nephrostomy , which involves bringing the drain to the interior of the kidney's calico-pelvic system. This procedure does not remove the obstruction, but drains urine by a different route. The last resort isnephrectomy , i.e. removal of the kidney.

Category:

Urology and Nephrology