Pathology in the genitourinary system associated with narrowing of the urinary canal is quite common. Such a violation is called ureteral stricture. The pathological process can affect the body, either completely or partially. Due to a malfunction in the urination system, urine either does not stand out at all, or it happens slowly. Acquired and congenital strictures are found.
Pathology Description
The ureter is a hollow tubular organ that connects the kidney to the bladder (in most mammals).
It starts from the narrowed section of the renal pelvis, where urine formed in the kidney flows. The output end ends in the wall of the bladder.
For a healthy person, narrowing of the ureter of an anatomical or physiological nature is considered an acceptable norm. A similar phenomenon occurs due to the elastic properties of its wall. However, in the event of stenosis or stricture, the changes begin to acquire a fibro-sclerotic form. As a result of this pathological process, there is a violation of the submucous membrane, as well as the muscular and external walls of the ureter. At the same time, some muscle elements die and are replaced by scar tissue, which is not capable of performing any functions, since it is atrophied.
Organ malfunction
The clearance of the urinary duct at the site of stricture of the ureter decreases, which disrupts the functioning of the organ in normal mode. Urine cannot be completely eliminated from the body and begins to accumulate in the bladder, eventually provoking increased pressure on the ureter. In the future, it stretches and lengthens. In some cases, it comes to the curvature of the ureter. In the absence of proper treatment, pathology affects the kidneys.
Ureteric stricture can develop in any area of the organ. Most often, the pathology is localized in the gap between the bladder and the ureter. In addition, there are cases of revealing stricture between the ureter and pelvis.
Varieties of strictures
The narrowing of the ureter can take different forms depending on the area of localization of the pathology, as well as on the nature of the disease. First of all, distinguished acquired and congenital stenosis. The latter appears in the process of fetal development of the unborn child.
The pathological process can occur due to thickening of the walls in certain places. Congenital ureteral strictures appear as a result of some disturbances in the development of the fetus, namely:
- An excess due to the curved shape of the ureter.
- The appearance of a membrane in the ureter valve, which provokes the accumulation of urine in the bladder.
- Ureterocele. This is a disease characterized by narrowing of the lumen in the lower part, while the ureter expands, and in some cases falls into the cavity of the bladder.
- Blood vessel pressure.
- The formation of diverticula, which provoke a protrusion of the lower part of the ureter.
The acquired form of narrowing of the ureter can occur under the influence of various factors depending on the state of human health. Depending on the area where the stricture was localized, right-side and left-side stenosis are distinguished. It also happens that both sides of the ureter are affected. Also, stenosis can be localized both in the upper part of the ureter, and in its lower part, where there is a transition to the renal pelvis. If the pathological process develops in the middle section, then both the upper and lower parts of the organ are affected.
Causes
There are a number of factors that provoke narrowing of the lumen of the ureter. These are developmental disorders at the genetic level in the case of a congenital form of pathology, which causes the formation of scar tissue instead of muscle walls. A variety of causes can cause the acquired form of the disease, but most often the injuries are the risk factor.
Provocative factors
Factors that can cause the development of ureteral stricture are:
- The formation of kidney stones. This applies to the category of internal injuries. Urolithiasis causes inflammation, and mucous membranes are easily damaged by stones, which leads to scarring.
- External injuries in the lumbar spine. As a result, a hematoma appears behind the peritoneum, which is subsequently the basis for stricture.
- Injury received during surgery.
- Radiation therapy, as well as radiation damage.
- Tuberculosis, inflammation in the ureter.
The causes of ureteral stricture should be determined by the doctor.
In addition, in some cases, the pathology appears as a result of gunshot or knife wounds. Also, independent treatment of sexually transmitted diseases can lead to injury to the ureter. Men are more prone to injuries and excessive physical exertion, so they are more likely to have strictures. If any of these factors are excluded, then the doctor concludes that the disease is congenital.
The code for ICD-10 of the ureteral stricture is N13.5.
Symptoms
As a rule, symptoms and severe pain accompany bilateral stenosis. Unilateral stenosis, by contrast, for the most part proceeds in a latent form. For this reason, it is almost impossible to diagnose a disease at an early stage of its development. With bilateral damage, the following symptoms are observed:
- Increased pressure in the arteries.
- Pain in the lower back.
- Nausea and vomiting.
- Convulsive syndrome.
- Isolation of a small amount of urine.
- Soreness during urination.
- An increase in body temperature, which indicates an inflammatory process in the body.
- The presence of urine impurities in the blood.
The symptoms of ureteral stricture are very unpleasant.
In the absence of proper treatment, the pathological process can progress and spread to adjacent organs, including the kidneys. Due to incomplete excretion of urine from the body, the risk of stagnation increases, which ultimately leads to urolithiasis, pyelonephritis, hydronephrosis, as well as chronic kidney failure. It is important to identify pathology in a timely manner and receive qualified medical care.
Diagnostic methods
To get the full clinical picture, it is necessary to appoint a detailed examination of the patient. Diagnostic procedures include blood and urine tests, an ultrasound of the genitourinary system. In addition, computed tomography and magnetic resonance imaging are prescribed for the patient. An endoscopic examination is contraindicated if the patient has an inflammatory process in the vagina, uterus, urethra or prostate gland.
Urethrography is considered the most informative and common research method for ureteral stricture. The procedure is an X-ray examination using contrast. This technique makes it possible to identify those areas in which there is stagnation, as well as to localize the presence and position of narrowed areas. Contrast is injected directly into the urethra or intravenously.
Preparation for urography
Urography is considered an effective, safe diagnostic method. A study is prescribed if there is a suspicion of renal pathology, diseases of the bladder, problems with filtration and urine output.
The basic rules for preparing for urography will be the following:
- 3 days before the procedure, the patient needs to refuse food, which provokes excessive gas formation.
- A test must be carried out without fail to detect an allergy to a radiopaque substance.
- Eating should be no later than 8 hours before the study, do not drink too much fluid throughout the day.
- You can’t eat in the morning.
- In the office you need to remove metal products, jewelry, as directed by a doctor, empty the bladder.
- If anxiety is present shortly before urography, you can drink a sedative (sedative) remedy.
Therapy
After a thorough examination and clarification of the diagnosis, the patient is prescribed the necessary treatment. The main goal of therapy is the normalization of urine excretion. The treatment regimen is selected based on the results of the studies. It is also important to consider the general condition of the kidneys and the genitourinary system. Another important factor in the selection of treatment is the size of the stricture.
The ureteric stricture is not treatable at home, as well as traditional medicine. Contrary to popular belief, it is impossible to warm the affected area, since the pain from this can become more intense.
One of the effective treatment methods is plastic surgery at urology centers. This is a rather complicated procedure, with a long rehabilitation period, therefore, it is prescribed only as a last resort. The operation is not suitable for every patient, as it has a number of contraindications.
Another treatment option is ureteral bougienage. A procedure is performed using a metal rod, which is inserted into the ureter and expands it. The procedure is very painful, while the effect of it is short-lived. Probing is rarely used.
Plastic replacement method
In the centers of urology, the method of plastic replacement is also used. This method is suitable for the treatment of small strictures, the size of which does not exceed 20 mm. The operation consists in making an incision and replacing the scar tissue with the patient’s tissue. In addition, an optical urethrotomy using a cystoscope is used. Any intervention for the treatment of stenosis should be coordinated with the attending physician and take place under the supervision of a qualified surgeon.
The pathology is quite serious, can not be treated with medical or folk methods. If you do not have surgery, complications may occur that affect the kidneys and other organs.
Prevention and prognosis
Stenosis develops rapidly, especially when it is preceded by injury. A hematoma forms in the affected area, which must be detected and the drainage procedure performed. With proper first aid, the formation of strictures is excluded. Any, even minor injury to the lower back requires contacting a specialist for examination and examination. It is important to avoid injuring the pelvic area when playing sports. It is important to use special protective shields that can soften the blow.
The sooner an operation is performed after strictures are detected, the better for the patient and the less chance of complications. In addition, this will shorten the recovery period, and the operation itself will not be so painful. An important point in proper rehabilitation is compliance with all the instructions of the attending physician.
Complications
If the above conditions are not observed, complications arise that can affect the functioning of the genitourinary system and other organs. The operation may also have consequences in the event that the patient's tissues have incorrectly fused or have not at all taken root.
Lack of treatment can lead to the development of pathologies such as cysts or kidney failure, as well as hydronephrosis, when the expansion of the renal pelvis occurs. In some cases, cystitis appears on the background of strictures, as well as kidney stones.