Ureterohydronephrosis: what is it, how dangerous is the disease? This question is asked by everyone who has been given this diagnosis. Ureterohydronephrosis, also called a megaureter, belongs to urological pathologies and is characterized by the expansion of the cup-pelvis complex and ureter. The disease is independent of age and gender, but judging by statistics, more often the pathology is diagnosed in women aged 20 to 35 years.
Ureterohydronephrosis. What it is?
A disease with such a complex name is notable for a difficult clinical picture. In urology, ureterohydronephrosis means atrophy of the renal parenchyma, which developed due to a violation of the outflow of urine from the kidney. The term "hydronephrosis" is used in medicine, it was coined by the French dermatologist Pierre Rayet. In 1891, he published a three-volume treatise on kidney disease.
With ureterohydronephrosis, the process of formation and reabsorption of urine persists, but its outflow from the pelvis is slowed down. This contributes to the accumulation of urine and increased pressure in the funnel-shaped cavity of the kidney. The cessation of the natural flow of urine contributes to the formation of muscular hypertrophy of the pelvis and calyx. Gradually, the funnel-shaped cavity and calyx of the kidneys become thinner, their fibers are destroyed, which disrupts the outflow of urine. This leads to dilatation (increase in volume) of the pyelocaliceal complex, followed by atrophy of the papillae and renal parenchyma.
A day after the closure of the lumen of the ureter, atrophy of the medulla of the kidney develops, the papillae gradually flatten. With complete closure of the ureter, numerous fornical ruptures appear, as a result, urine is thrown into the extracellular renal space, the circulatory and lymphatic systems. With an increase in intraparenchymal pressure, atrophy of the renal pyramids develops.
ICD-10 ureterohydronephrosis has the code N13.2.
Causes Affecting the Occurrence of a Disease
There are mechanical and neurodynamic theories of the origin of the disease. The causes of the pathology can be caused by obstruction of some part of the urinary system or urine reflux caused by the failure of the bladder valves. According to localization, the causes are external and internal.
Internal factors for the development of ureterohydronephrosis:
- Neoplasms.
- Fibroepithelial polyps.
- Fungal lesions of urine.
- Endometriosis
- Urolithiasis disease.
- Bladder diverticulum.
- Cystocele.
- Bladder neck contracture.
- Tuberculosis.
- The presence of blood clots.
External causes of hydronephrosis:
- Retroperitoneal lymphoma.
- Cervical cancer.
- Ovarian cysts.
- Pregnancy.
- Tubal-ovarian abscess.
- Tumors of the prostate.
- Lymphocele.
- Improper location of the renal artery.
- Aneurysm of the abdominal aorta.
- Pelvic lipomatosis.
- Hyperplasia of the prostate.
Also, pathology can develop due to functional reasons: reverse urine reflux from the bladder into the ureter or the presence of a neurogenic urea.
Pathology classification
Modern classification implies a separation depending on the time of development, severity, course, localization.
By development time:
- Congenital ureterohydronephrosis or primary develops due to malformation of the pyelocaliceal complex, ureter, kidney parenchyma.
- Secondary (acquired) - a consequence of complications of urolithiasis, damage to the urinary tract, tumors of the ureter, kidney.
By localization:
- Unilateral. In urology, ureterohydronephrosis on the left and right is diagnosed with the same frequency.
- Bilateral is observed in 5-9% of cases.
In the course of the disease:
- Acute ureterohydronephrosis with timely detection and correction is completely cured. Renal function is fully restored.
- In a chronic course, kidney function is not restored.
According to the severity of the current, 3 stages are distinguished:
- Stage I (mild) - renal function is mild or not altered at all.
- Stage II (moderate) - the pelvis is enlarged, the kidney is increased in size by 15-20%, and its functionality is reduced by 40%.
- Stage III (heavy) - an enlarged 2-fold kidney is a multichannel cavity. Function reduced by 80% or completely absent.
Depending on the severity of a decrease in renal tissue, 4 degrees of ureterohydronephrosis are distinguished:
- The first - the parenchyma is saved.
- The second - the kidney tissue is slightly damaged.
- Third - significant damage to the parenchyma is observed.
- Fourth - lack of parenchyma, complete non-functional kidney.
How is the pathology manifested?
What is ureterohydronephrosis? This has now become clear, consider its manifestations. The disease often develops against a background of another pathology. Often it is asymptomatic, manifests itself during infection, trauma or is detected by accident (ultrasound during pregnancy, suspected gynecological or "male" diseases). Clinical manifestations depend on the location, flow rate, duration of violation of the outflow of urine. The severity of symptoms depends on the degree of expansion of the pelvis and calyx of the kidneys.
The most common manifestations are:
- Pain in the lumbar region of varying intensity. For an early stage, attacks of renal colic are characteristic, later the pain becomes aching.
- An increase in the type of bloating of the lower abdomen. This manifestation is characteristic of ureterohydronephrosis in newborns.
- Dysuric phenomena. Patients note a decrease in the amount of urine while urinating to urinate more often. The deurination process itself is painful.
- Swelling develops as a result of accumulation of urine in the extracellular spaces of the renal parenchyma.
- Fatigue, chronic fatigue, increased blood pressure develop in the late stages of pathology.
- Ureterohydronephrosis is characterized by macrohematuria (visible with the eye) and microhematuria (detection of blood in the urine in a laboratory). This symptom is not uncommon, and sometimes even the only one.
Complications
Complications arise, as a rule, in the chronic course of pathology:
- Urolithiasis disease.
- Pyelonephritis. Damage to the tubular system of the kidney with infection.
- Hypertension aggravates the hydronephrotic transformation of the kidney even more.
- When introducing infection, the likelihood of developing sepsis is high.
- Renal failure. With this complication, the patient dies from intoxication of nitrogen metabolism and a violation of the water-salt balance.
- The rupture of the hydronephrotic sac and the discharge of urine into the retroperitoneal space can also cause the death of the patient.
Ureterohydronephrosis in young children
Pathology is also diagnosed in small patients. The disease is not only congenital, but also acquired.
Symptoms of ureterohydronephrosis in children in the neonatal period are manifested in the form of anxiety, unstable stool, an increase in the abdomen, especially its lower part. A sharp lag in physical development is observed. Older children have abdominal pain, renal colic, macro- and microhematuria. Often the main symptom is chronic leukocyturia.
In children, the affected kidney quickly reaches enormous size, an extrarenal arrangement of the tense pelvis is often observed. Reduced blood circulation significantly increases the likelihood of a secondary infection. With bilateral ureterohydronephrosis, renal failure rapidly develops.
How is the diagnosis
Diagnostic measures for children and adults are the same:
- When collecting an anamnesis, the doctor finds out the reasons that contribute to the development of pathology.
- Physical data is uninformative. Palpation is able to recognize ureterohydronephrosis only in the later stages.
- X-ray contrast studies play a major role in diagnosis. The method allows you to determine the size of the kidney, to judge the excretory function of the kidney. On the ureterogram, the zones of inflection, strictures, and additional vessels are clearly visible.
- Ultrasound of the kidneys allows you to evaluate the size of the organ, the condition of the pelvis, calyx, ureter, the presence of additional tissues.
- An ultrasound scan of the bladder reveals changes in the ureteropelvic segment.
- Laboratory tests are carried out not only during diagnosis, but also during the treatment of ureterohydronephrosis. In children, urine is examined by the Kakovsky-Addis method, with which the number of formed elements of urine is determined. Blood biochemistry shows an excess of urea, changes in the level of sodium and potassium.
Differential diagnosis
Be sure to carry out a differential diagnosis of ureterohydronephrosis of the kidney from pathologies of the abdominal organs and other diseases. The most effective methods of differentiation are survey radiography and pneumopyelography. Hydronephrosis has much in common with the following diseases:
- Nephrolithiasis
- Nephroptosis
- Tumor of the kidney.
- Polycystic
- Solitary cyst of the kidney.
Conservative treatment
What is ureterohydronephrosis, what is the therapy? Patients are primarily interested in whether pathology can be cured by conservative methods. Unfortunately, non-surgical methods of therapy do not bring positive results.
Drug therapy can be aimed at eliminating pain, infection, lowering blood pressure, and correcting kidney failure.
Surgical Therapies
There are several types of surgical treatment:
- Reconstructive. Plastic surgery is performed if the function of the parenchyma is disrupted by no more than 20%, and the reason why the disease has developed can be eliminated.
- Organ conservation operations. The method can be applied if the transformation of the kidney occurred due to obstruction of the urinary tract. The most common is the Foley operation, which creates a funnel-shaped expansion of the proximal ureter.
- Organo-removing. Indications for the removal of the kidney are the loss of its functions and a high risk of complications. With bilateral ureterohydronephrosis, nephroectomy is strictly contraindicated.
Disease Monitoring and Prevention
The rapid elimination of the causes of pathology allows the kidney to quickly restore its functions due to reserves. In the chronic course of ureterohydronephrosis or infection, the prognosis is usually unfavorable.
The most effective method of prevention is a regular examination by a urologist, as well as the prevention of urinary tract pathologies.