The term "megaureter" refers to a pathological condition, which is characterized by an expansion of the lumen of the ureter. As a result, the outflow of biological fluid is impeded. A natural consequence is a violation of the kidneys. In children, the megaureter is innate. With timely treatment, the prognosis is usually favorable. Currently, there are several methods of surgical treatment of megaureter in children.
Pathogenesis
The bladder is an organ related to the excretory system. It is located in the pelvis. The upper part is located in the umbilical ligament zone, the lower, narrowing, forms the neck, passing into the urethra. Approximately in the middle is the valve apparatus. It is represented by two ureters located at an angle. Such placement prevents urine outflow back if the bubble is already completely filled with liquid.
A person begins to feel the urge to urinate when about 200 ml of biomaterial is accumulated in the body. In case of emergency, the bubble can hold up to 750 ml of urine, but in this situation, a person will feel pronounced uncomfortable sensations. However, in the opposite direction, the biological fluid still does not move.
Under the influence of various adverse factors, an increase in the diameter of the ureter occurs. It also lengthens, leading to kinks. A logical consequence is stagnation of urine. Biological fluid simply can not move freely into the bubble. In addition, with a megaureter, part of the urine can be thrown back. As a result, the pathogenic flora can penetrate the renal pelvis.
According to statistics, most often a megaureter is diagnosed in boys. In this case, the pathology, as a rule, is bilateral in nature, that is, the sizes of both ureters change at once.
In most cases, a pediatric urologist identifies pathology in children aged 3 to 15 years. But at the same time, this ailment can be found both in the newborn and in the fetus, which is still developing in the womb (the study that is carried out after the 16th week of pregnancy is informative).
Etiology
The disease can be both primary and secondary in nature. Congenital anomaly is associated with a violation of intrauterine development. Acquired pathology is more common in adults, but in children its occurrence may be a consequence of the course of various diseases.
The main causes of megaureter in a newborn baby:
- During intrauterine development, a narrowing of the lumen of the canal occurred in the area of its connection with the bladder.
- Polycystic kidney disease.
- Narrowing of the lumen and cramping in individual sections of the canal. In this case, it is customary to talk about dysplasia.
- The presence of cysts in the urethra.
- Various kinds of abnormalities in the development of the kidneys. For example, their doubling or fusion in any case leads to changes in the size of the ureter.
- Thickening of the walls of the channel. As a result, the diameter of the ureter becomes smaller, due to which it functions less efficiently.
- Blood vessel deformities.
- Underdevelopment of muscle tissue in the ureter. The tone of its walls is reduced, the process of outflow of biological fluid is complicated.
Thus, most often the megaureter in children is congenital. Failures in the period of intrauterine development occur if the expectant mother eats poor-quality food, is fond of smoking and drinking alcohol-containing drinks, has regular contact with harmful chemicals, and suffers from autoimmune pathologies or dangerous infectious diseases.
Regardless of the causes of the megaureter, it is impossible to delay the treatment of the disease. This is due to the fact that ignoring the pathology leads to serious complications.
Clinical manifestations
The danger of the disease lies in the fact that in some cases it is asymptomatic. A child can feel good and remain active throughout the day.
The first alarming sign is the fact that the baby empties the bladder not in one but in two approaches. After a certain amount of biological fluid has leaked out, the organ is again filled with urine, but already the one that until this moment accumulated in pathologically altered areas. In this case, the second portion of urine differs from the first volume, pungent odor and cloudy sediment.
As a rule, a megaureter is detected at random or during diagnosis at a pediatric urologist appointed for another disease, which in fact is already a complication.
As the disease progresses, the following symptoms appear:
- Constant thirst.
- Nausea turning into vomiting.
- Fever.
- General malaise.
- The specific smell of ammonia from the oral cavity.
- Bloating.
- An increase in body temperature to subfebrile values.
- Deterioration of the skin.
- Pain in the abdomen and lower back. Often they radiate to the upper body or lower limb.
With a bilateral megaureter, the condition of the child worsens significantly. In this case, the pathology is easy to detect even immediately after the baby is born. The child is rapidly developing an intoxication process and chronic renal failure, in connection with which he refuses breast milk or a mixture. His body is extremely weak and dehydrated.
In case of untimely detection of anomalies, bone structures develop incorrectly. There is a deformation of the skeleton and a change in the size of the abdominal organs.
Forms and stages of development
The severity of the clinical manifestations of the disease depends on its type. Doctors classify the disease depending on the mechanism of its development.
Types of ureteral megaureter:
- Obstructive. A narrowing of the lumen is formed directly at the interface between the bubble and the channel. As a result, outflow of urine is difficult. The fluid begins to exert pressure on the bladder and this injures him.
- Refluxing. In this case, urine can come back, that is, this process is not physiological. When the fluid moves backward, the ureter tissue also experiences increased pressure and, as a result, stretches.
- Mixed. This type of disease has signs of both obstruction and reflux.
- Cystic. Urine accumulates in the organ, which, without flowing out, begins to exert pronounced pressure on the soft tissues. The consequence is the destruction of the ureter anastomosis valve. As a result, urine moves in the opposite direction.
The development of a megaureter in children goes through several stages. There are three of them:
- Achalasia. This is the stage of compensation, the pathology proceeds in a latent form. As a rule, in this case, the ailment is detected randomly. When diagnosing a megaureter in a newborn baby, the baby is registered. For 2-6 months, it is observed without resorting to surgical methods of treatment. This is due to the fact that in newborns the organs of the genitourinary system are not fully matured, and therefore the pathology can disappear on its own. But if the channel is deformed so much that the child’s condition is unsatisfactory, they immediately begin surgery.
- Progression. It is directly a megaureter. Symptoms characteristic of the disease appear at this stage.
- Complications Ignoring the pathology or its illiterate treatment leads to impaired renal function.
There are 5 stages of the development of the disease. At the same time, the first changes are so insignificant that they are almost imperceptible. In the fifth stage, the ureter is deformed as much as possible. In addition, the kidney is completely affected.
Diagnostics
As mentioned above, if the anomaly is congenital in nature, it is easy to detect during pregnancy by ultrasound. If the doctor has suspicions of an ailment, he gives a referral for examination, which will be carried out shortly after birth.
The main method for diagnosing pathology is ultrasound. In addition, a UAC analysis is assigned. The decoding of the study is done by the doctor. The indicator of ESR is clinically significant. The presence of anemia can also indicate the presence of pathology.
Other methods for diagnosing megaureter in children:
- Cardiotocography of the kidneys.
- Analysis of urine.
- Cystography.
- Nephroscintigraphy.
- Intravenous urography.
- Uroflowmetry.
- Retrograde urography.
- Cystoscopy.
If the doctor has chosen the tactics of observation, ultrasound and analysis of the UAC are periodically prescribed. Deciphering the study allows us to assess the dynamics of changes and, when deviating to a larger side of clinically significant indicators, take timely measures.
Surgical treatment
If the child has enlarged ureters, conservative methods are ineffective. Based on the diagnostic results, the doctor chooses the method of surgical intervention.
Methods of surgical treatment of megaureter in children:
- Reconstruction followed by resection. The affected structure is excised and restored anatomically. If reconstruction is not possible, intestinal plasty is indicated. The ureter in this case is formed anew. If intestinal tissue is insufficient, biomaterial is taken from the wall of the bladder.
- Ureterocutaneostomy. This term refers to a method of intervention, during the implementation of which the ureter is brought out. As a rule, this method is used only if the patient is in an extremely serious condition. This is due to the fact that the operation is associated with a high risk of infection.
- Anastomosis. During the intervention, the surgeon removes the pathologically expanded area and then stitches healthy tissues together. With a megaureter, surgery is indicated only if only a small area is affected.
- The introduction of the affected ureter into the skin.
Prior to or after surgery, a temporary discharge of the urinary tract is performed. This is necessary in order to restore the normal functioning of the kidney. To do this, a pelvis is pierced and a catheter is inserted into the organ, through which biological fluid is removed to the outside.
If changes in the ureter and kidney are irreversible, both organs are removed.
Minimally invasive methods
Currently, there are several methods that are a worthy alternative to traditional surgical intervention. Minimally invasive techniques are performed using endoscopic equipment.
Megaureter treatment methods:
- Bougienage. The doctor inserts a catheter or stent into the ureter. Due to the presence of the probe in the channel, the biological fluid in it does not accumulate and freely exits the body.
- Balloon dilatation. During the operation, a special hollow catheter is used. Inside it is a cylinder filled with liquid or gas. In this case, the doctor can monitor and change the volume of this container. Thanks to this, the specialist gets the opportunity to expand the pathologically narrowed sections of the ureter.
- Endoscopic therapy. The doctor introduces an optical probe into the affected area. After detecting a pathologically altered area, a specialist using endoscopic equipment introduces a medical volume-forming gel into it.
Minimally invasive methods are not used to treat severe forms of pathology. In such cases, they are ineffective.
Effects
In case of untimely access to a doctor in the body, the process of irreversible changes starts. The following complications are most often diagnosed:
- Enlarged renal pelvis.
- Hemodynamic impairment.
- Increased pressure inside the kidney.
- Violation of the functioning of the organs of the excretory system.
- The development of chronic renal failure.
- The occurrence of arterial hypertension.
In addition, with megaureter it often happens that urine moves in the opposite direction. Moreover, it already contains a pathogenic flora. As a result, infectious diseases and sepsis develop.
Forecast
The outcome of the disease directly depends on the timeliness of going to the doctor. If the changes in the ureter are minor and they are detected immediately after birth, the baby must be observed for several months. In 80% of cases, the megaureter passes independently. If this does not happen, but the pathological process does not progress, the prognosis is considered conditionally favorable. In this case, the organs of the urinary system work in a limited mode. The decision on the advisability of the operation should be made only by a doctor.
If the condition of the child is serious, surgery is performed immediately. The choice of technique depends on the age of the patient, the degree of deformation of the ureter and the presence of complications.
Finally
The term "megaureter" refers to a pathological condition in which there is a change in the diameter of the ureter. As a rule, in children the disease is congenital. In this case, developmental abnormalities occur most often against the background of an unhealthy lifestyle of the expectant mother. Currently, there are several methods of surgical treatment of megaureter. At the initial stages of the development of the disease, it is advisable to use minimally invasive methods.