Stones in the kidneys, ureter and bladder and treatment methods

Kidney stones and treatment methods

The appearance of kidney stones is a natural result of drinking hard water, which has a high salt content.
It has been statistically proven that in areas with soft water, kidney stones are extremely rare for people to form. Salts coming from outside necessarily pass through the kidneys in the process of filtering the blood. If a person does not drink enough fluid, the salts form crystals that gradually accumulate in the pelvis. The situation is aggravated by diseases of the thyroid and parathyroid glands, disorders of the nervous system, and congenital developmental anomalies. The causes of kidney stones are varied, and it is not always possible to figure them out. The kidneys regulate water-salt metabolism, so they almost always suffer due to poor nutrition, water starvation, stress, infection, etc.

Kidney stones are three times more likely to form in men than in women. However, kidney stones in women are coral-shaped, while in men they are round. Coral stones are more dangerous because... fill the entire kidney and are more difficult to get rid of.

Thanks to the improvement of diagnostic and therapeutic equipment, stones in the bladder, ureter and kidneys are detected in the early stages, when they are still small. Modern methods of crushing kidney stones - remote and contact lithotripsy - turn stones into tiny particles that are passed naturally through urine.

The head of the endourology department at the Best Clinic on Krasnoselskaya, Doctor of Medical Sciences Suleymanov Suleiman Israfilovich, in the Medical Council program, talks in detail about all aspects of the diagnosis and treatment of urolithiasis.

Structure and functions of the urinary system

The human urinary system is represented by the kidneys, ureters, urethra and bladder.

Main functions of the system:

Release of metabolic products;
Maintaining water-salt balance in the body;
Hormonal function due to biologically active substances synthesized by the adrenal glands.

It should be noted that the functions of excreting and maintaining homeostasis are vital.

Bud

The kidney is a bean-shaped parenchymal organ consisting of a cortex and medulla. The kidney is located in the lumbar region.

From the inside, blood vessels (inferior vena cava and aorta) enter the kidney through the renal gate. In turn, the ureters emerge from the kidneys in the same place.

On the outside, the organ is covered with fatty and connective tissue capsules.

The structural and functional unit of the kidney is the nephron - a collection of glomeruli and excretory tubules.

In general, the kidney is an organ that plays a major role in the detoxification process of the body. The remaining organs of the urinary system perform only the functions of storing and excreting urine.

Ureter

The ureter is a hollow tube with a length of up to 32 cm and a lumen thickness of up to 12 mm. The size of the ureter is purely individual and depends not only on a person’s height and build, but also on genetic factors. So, with developmental anomalies, the length may differ sharply from the indicated one.

The wall of the ureter has several layers:

Internal (mucous) – lined with multilayered transitional epithelium;
Medium (muscular) - muscle fibers are oriented in different directions;
The outer (adventitial) consists of connective tissue.
The function of the ureter is to remove urine from the kidneys by contracting muscle fibers and maintaining normal urodynamics.

Bladder

This is a hollow organ in which urine accumulates until the moment of urination. The signal for the urge to urinate is the volume of accumulated urine of 200 ml. Bladder capacity varies, but the average is 300-400 ml.

The bladder has a body, a bottom, an apex and a neck. Its shape changes depending on the degree of filling.

The wall on the outside is covered with a serous membrane, followed by a muscular (smooth muscle tissue), inside the bladder is lined with a mucous membrane consisting of transitional epithelium. In addition, glandular epithelium and lymphatic follicles are present. The muscle tissue is not homogeneous and generally forms a detrusor, which has a narrowing closer to the bottom - the sphincter of the bladder.

Urethra

Immediately from the bladder, urine, under the influence of muscle contractions, enters the urethra. Further, through the urethra (sphincter), it is released into the environment.

The urethra, like the ureter, consists of three layers. The epithelium of the mucous membrane varies depending on the location. In the prostate area (in men), the mucous membrane of the urethra is covered with transitional epithelium, then with multilayer prismatic epithelium, and finally, in the head area with multilayered squamous epithelium. On the outside, the canal is covered with a muscular layer and connective tissue consisting of fibrous and collagen fibers.

It should be noted that in women it is shorter than in men, which is why women are more susceptible to inflammatory diseases of the urogenital tract.

I offer you a visual video “Structure of the human urinary system”

Diseases of the urinary system

Diseases of all components of the urinary system can be infectious or congenital genetic. During the infectious process, specific structures, mainly the kidneys, become inflamed. Inflammation of other organs, as a rule, is less dangerous, but leads to unpleasant sensations: pain and pain.

Genetic diseases are associated with structural anomalies of a particular organ, usually anatomical. As a result of such disorders, the production and excretion of urine is difficult or impossible.

Developmental anomalies can also be classified as genetic diseases. In this case, instead of two kidneys, the patient may have one, two, or none at all (as a rule, such patients die immediately after birth). The ureter may be absent or may not open into the bladder. The urethra is also subject to developmental abnormalities.

Women are more likely than men to be at risk of contracting infectious agents because their urethra is shorter. Thus, the infectious agent can rise to higher organs in less time and cause inflammation.

Last update 05/01/2017

nashipochki.ru

Symptoms of stones in the kidneys and ureter

The symptoms of kidney stones are determined by the size and shape of the stone. Large stones do not manifest themselves for a long time, but as they grow larger, a person increasingly feels a dull, pulling pain in the lower back, and blood appears in the urine. Such a calculus worsens the conditions for urine excretion.

Small stones are more mobile, they move with physical activity, drinking large amounts of liquid and shaking. When stones in the kidneys and ureters begin to move, urine cannot pass due to blockage of the excretory tract. A stone present in the ureter causes characteristic symptoms that fit into the picture of renal colic. This is severe pain, frequent urge to urinate, increased blood pressure, nausea and vomiting, and increased body temperature.

If kidney stones are detected, treatment should begin immediately.

What is ureteral dilatation and what are its causes?

Enlargement of the ureter is a disease that causes structural changes in the organ and seriously impairs urinary functions.

Ureter

The pathology provokes infection and obstruction of the urinary system, as well as serious kidney damage.

Genitourinary system

The ureter belongs to the category of paired organs. It is the link between the renal pelvis and the bladder.

Its functions include ensuring the normal (natural) outflow of urine from the kidneys. Externally, it is very similar to cylindrical tubes, which are slightly flattened in diameter.

Their length depends directly on the height of the kidney organs; most often it ranges from 24 to 35 cm.

In newborns, the length of the ureter is only 7 cm; as the child grows, the length of the organ increases.

At the age of two it already reaches 14 cm, at the age of three – 21 cm, and by the age of eighteen the growth of the ureter stops and the length is finally fixed.

The ureter consists of three parts:

abdominal;
pelvic;
intramural.

Organ functions

In three places, narrowings are observed, predetermined by its physiological structure. They are located in the area of the connection with the kidneys, bladder and in the area of \u200b\u200bthe intersection of the common glomerular vessels.

The mucosa, adventitia and muscular layers make up the three-layer walls of the ureter. The mucous membrane differs from the rest in that it forms folds throughout the ureter.

The muscular one is also noted to have a three-layer structure; muscle bundles are located on each section of the ureter in completely different ways.

In the upper part there is a longitudinal and circular arrangement, in the abdominal part there is a spiral shape, and in the pelvic part there are twisted shapes. The outer layer is equipped only with horizontal muscle fibers.

The functioning of the ureter depends to a large extent on the functioning of the kidneys, renal pelvis, and bladder.

The coordinated work of the entire urinary system ensures a normal urination process. Urine moves freely through the ureter due to peristaltic contractions.

Description

Enlargement (increase in size) of the ureter is in most cases a congenital disease, although there are rare examples when such a serious disorder was acquired by a person during life.

Stones in the ureter

The disease is characterized by an abnormal expansion of the diameter of the ureter or an excessive increase in its length. This causes disturbances in the urinary process due to possible kinks in various parts.

In the presence of large stones, the outflow of urine slows down sharply, since its normal movement is hampered by obstructions occurring in the ureter itself.

Congenital pathology is quite rare, affecting only 0.7% of newborns, while it is diagnosed four times more often in boys than in girls.

Of all congenital cases with such dilatation, every fifth is characterized by simultaneous damage to both ureters.

This abnormality is classified into primary and secondary. In the first case, the disease concerns only the ureter itself, and in the second, its appearance is preceded by some other disorders of the internal organs of a person.

In medical practice, there is a classification of ureteral dilatation in relation to renal dysfunction.

The first degree is characterized by a decrease in renal activity by up to 30%, the second already indicates a decrease in kidney performance by 30-60%, and the third, the most serious degree, is characterized by a sharp drop in performance by more than 60%.

Forms

When studying etiological factors, three main forms of ureteral dilatation are determined: obstructive, refluxing, and bladder-dependent.

Detection of pathology

Obstructive expansion is characterized by all kinds of anatomical obstacles. Most often, obstructions are located in the lower part of the ureter, where it connects to the bladder.

Due to the fact that urine cannot flow freely into the urinary organ, it acts on the walls of the ureter, exerting extreme pressure. This is what provokes its further expansion.

If such a deviation is not diagnosed and, accordingly, the correct treatment is not prescribed, this will lead to serious kidney damage.

Unfortunately, in most cases, obstruction cannot be treated conservatively, so doctors resort to surgical intervention.

Refluxing dilation is caused by vesicoureteral reflux, when urine from the bladder flows through the ureter back to the kidney.

If no pathological changes are observed in the urinary system, then the urine does not tend to move backward.

Pathologies of the genitourinary system

Vesicoureteral reflux can provoke not only dilation of the ureter itself, but also an enlargement of the bladder itself, due to the fact that emptying does not occur, and urine circulates between these two organs through the vesicoureteral junction.

This deviation is classified as severe. More often diagnosed in newborn boys. During the first year of life, in some cases positive changes are noted.

If such encouraging prospects are still not observed, doctors have to perform surgical operations, during which actions are aimed at narrowing the diameter of the ureter or its reimplantation.

If neither obstruction nor reflux are responsible for the fact that the ureter suddenly turns out to be dilated, then non-refluxing non-obstructive dilation is diagnosed, which quite often can resolve completely without medical intervention.

But even this form of disorder must be under constant medical supervision in order to exclude other anomalies.

Refluxing and obstructive dilatation is the most dangerous form, since the ureter increases excessively in size, which subsequently leads to complete obstruction.

Causes of dilatation

Dilatation of the ureter develops due to a violation of the outflow of urine from its lower parts or from the bladder itself.

Stone in the ureter

The most important and most common cause of dilation of the ureter is urolithiasis.

Quite often, obstruction is caused precisely by the presence of several stones or just one, but having a fairly large size.

The outflow of urine can also be impaired due to a sharp narrowing of individual parts of the ureter. These can be congenital pathologies, when the newborn has practically no urethral lumen.

If the right kidney occupies an unusual natural location and drops a little lower, then a kink in the ureter is diagnosed, which provokes its stricture.

Oncology

Various tumor formations can affect the ureter, squeezing it from all sides; such an effect also provokes obstruction of the ureter.

The inflammatory process occurring in the ureter itself or other organs of the urinary system provokes swelling of the mucous membrane, as a result of which the lumen sharply narrows, and this contributes to the disruption of the outflow of urinary fluid.

A disease such as urethrocele can also become an obvious cause of dilatation of the ureter, due to the fact that a cavity is formed in the lower part of the urethra, and all overlying parts of the ureter expand.

Hollow formations called diverticula may be observed in the walls of the urethra. They can concentrate urine, which tends to stagnate.

Over time, this leads to the formation of stones, which in turn cause obstruction.

Symptoms

If the bladder and urethra are not affected by any pathological changes, then the expansion of the ureter itself almost always occurs in a latent form and does not show any symptoms in the first stages.

Urinary disorders

But over time, when the pathology develops more extensively, characteristic signs begin to appear in any case.

Biphasic urination is the surest sign indicating dilation of the ureter.

The first portion of urinary fluid leaves the bladder, while it is instantly filled with the next portion of urine, concentrated up to this point in the dilated ureter.

Therefore, after bowel movement, a person immediately feels the urge to urinate again. The second time, the amount of urine is greater, it has an unpleasant, foul odor, as well as a cloudy appearance.

Pathology often provokes concomitant diseases, so dilatation of the ureter is also characterized by symptoms of some other diseases of the urinary system, such as chronic pyelonephritis, chronic renal failure, ureterohydronephrosis.

Symptoms of pathology

All of them are characterized by pain in the lumbar region.

In some cases, when the ureter expands, the body temperature rises, a gag reflex appears, and hematuria in the urine is also observed, sometimes even persistent pyuria, especially in cases where there is a concomitant inflammatory process.

Urinary incontinence is also one of the symptoms of this pathology.

With bilateral dilatation of the ureters, rapid pathological changes are observed, leading to chronic renal failure, as a result of which appetite decreases, rapid loss of strength occurs, severe thirst, changes in the skin are observed, severe anemia and polyuria are diagnosed.

Congenital pathology of ureteral dilatation is detected long before the baby is born.

Three weeks after birth, the child is sent for a comprehensive urological examination to establish the exact causes and determine the stage of development of the pathology, and then prescribe effective treatment.

Urography

In other cases, such a pathology is diagnosed when a patient presents with certain complaints.

In most cases, an infection of the urinary system is suspected, since many of the symptoms are the same.

Initially, the patient is sent for an ultrasound examination, which allows one to determine the presence of stones in the ureter and inflammatory diseases.

During an ultrasound examination, the doctor determines the location of the internal organs, thus detecting possible prolapse of the kidney and the subsequent bending of the ureter.

Ureteral examination

Options for promising tools for conducting urological studies also include urography, which involves the use of a contrast agent.

During urography, images are taken that show the movement of this radiopaque component along the urinary tract.

Such a study makes it possible to detect in what place there is an obstruction, where the stones are located, and what their sizes are. The doctor can evaluate the size and pathological changes of the diverticulum.

Possible kinks of the ureter and prolapse of the kidney are also visible on urographic images.

Urethrography also allows you to observe changes in the body.

This type of diagnostic study also involves the introduction of a contrast agent, but it is only administered against the flow of urine. A radiopaque contrast agent is also required when performing cystography.

Laboratory diagnostics

Absolutely accurate information about the corresponding disorders can be obtained during cystoscopy, when a small sensor with a video camera installed in it is inserted into the bladder, allowing the doctor to observe all changes from the inside.

In the same way, you can observe changes in the urethra by performing urethroscopy.

Laboratory research methods are useful, since the results of blood and urine tests can indicate an inflammatory process, as well as urolithiasis.

With conservative treatment, diagnostic studies every six months are considered mandatory in order to be able to monitor the effectiveness of treatment and, if necessary, make the necessary adjustments.

If, during laboratory and instrumental diagnostic studies, disorders associated with the expansion of the ureter are detected, the doctor must prescribe appropriate treatment.

Unfortunately, only in the presence of a bladder-dependent form is conservative treatment possible; in other cases, only surgical intervention is indicated.

The operation can solve several problems: reduce the diameter of the ureter, shorten its length. The main goal of such surgical actions is to restore the passage of urinary fluid.

It should be noted that when dilatation of the ureter is detected in children, a wait-and-see approach is adopted, during which all changes occurring in the child’s body are carefully monitored.

This tactic is followed due to the fact that in 70% of cases the pathology can resolve on its own. Most often, this occurs before two years of age due to the maturation of internal organs, including the ureters and kidneys.

Surgery

Surgery is performed when there are no signs of self-resolution of the problem, and the pathology has a negative effect on the functioning of the kidneys, which, with prolonged inactivity, can cause renal failure.

During the operation, doctors perform reimplantation of the ureter, as well as antireflux therapy.

In some episodes, when the pathology has taken the most severe forms, the ureter is implanted into the skin (formation of a ureterostomy). This allows you to restore normal kidney function.

Plastic

Surgeons can also reconstruct the ureter, which involves transverse resection to reduce the length or longitudinal resection to reduce the diameter. After resection it is sutured.

In some situations, even intestinal plastic surgery occurs, when a new replacement organ is formed from a small part of the intestine.

During surgery, diverticula are removed only when they interfere with the normal process of urination.

Minimally invasive technologies, including laparoscopic operations, unfortunately, are not performed in the case of ureteral reimplantation. Doctors perform abdominal surgeries, which are classified as complex. But due to the fact that such operations are performed frequently, doctors perform them quite highly professionally, due to which postoperative complications occur quite rarely.

Unfortunately, there are cases when the patient seeks medical help too late, as a result of which he experiences irreversible processes in the functioning of the kidneys and other organs.

In such patients, only nephroureterectomy is indicated.

With timely treatment and surgical intervention, further prognosis is positive. But any delay can lead to inevitable death of the kidney.

If, a few months after the operation, renal failure does not develop, the patient can return to his previous way of life, there are no restrictions even for physical activity.

That is why doctors recommend seeking help when the very first symptoms occur.

promoipochki.ru

Types of kidney stones and what sizes they reach

There are 3 types of stones, they are divided according to their chemical composition:

oxalates - are formed more often than others when urine is acidified, and are found when consuming large amounts of meat, smoked meats, and pates;
urates - formed in an acidic environment, dense, difficult to crush, reminiscent of beans;
phosphates - appear in an alkaline environment, found in lovers of dairy, cheese, cereals, and white bread.

The sizes of stones may vary. As mentioned above, the course of the disease depends on this.

Blood supply and innervation

Blood supply comes from the work of the renal arteries.
The upper segments, such as the proximal ureter, receive their blood supply from the renal arteries. The central parts are supplied with blood through the iliac arteries, the vesical and rectal, if these are male organs. And if this is a female body, then the juxtavesical section of the ureter is supplied with blood with the participation of the uterine and vaginal arteries. Vessels in the form of a loop are located in the adventitia. Blood enters the intramural section of the ureter thanks to its own small arteries. Parallel to the arterial blood supply, venous and lymphatic drainage occur. Anastomization of the arteries allows surgical interventions in the urinary system without disrupting the blood supply.

Innervation

Innervation is the connection between an organ and the central nervous system. Following neuromorphology, two sources of innervation pass through the ureter:

Nervous connection between the renal pelvis and calyces. Provided by resources located higher than the branches of the renal plexus.
Communication of the upper sections is carried out by intramural nerve ganglia. They pass through the intravesical and juxicavesial parts. The blood supply to the ureter passes near the nerve supply system.

The upper section is innervated by nerve fibers from the renal plexus, as well as by parasympathetic branches originating from the vagus nerve. The middle parts are supplied by branches of the lumbar region. There are α- and β-receptors in the walls of the organ, as in other organs. Therefore, spasms in renal colic can only be blocked by drugs that stop alpha receptors. And drugs that block beta receptors relieve spasms only in 3% of cases.

Diagnosis of kidney stones

The final diagnosis at Best Clinic is established within 2-3 days, after which the doctor draws up an optimal treatment program. At the examination stage the following is carried out:

general clinical blood and urine tests;
biochemical blood test;
bacteriological urine culture;
Ultrasound of the kidneys to assess the morphology of the formation;
excretory urography - X-ray examination with contrast;
CT scan of the urinary system is the most modern and accurate method, used when ultrasound and urography are not informative.

When kidney stones are detected, what should you do? It is important to take measures to prevent the development of complications of urolithiasis. As part of complex treatment, stone removal is indicated.

3. Symptoms and diagnosis

Taking into account the nature of the most common reasons, there is no need to talk about any subtle nuances of subjective sensations in this case. Almost any damage to the upper urinary tract and kidneys is accompanied by intense pain, and sometimes painful shock; in the case of polytrauma or multiple penetrating wounds, the person is not always conscious, and sometimes minutes count.

The most informative and logical objective symptom of a foreign body in the kidney or ureter is hematuria, i.e. the presence of one or another concentration of blood in the urine. However, this sign is not pathognomonic (inherent exclusively to this condition and never occurs in any others). As a rule, all differential diagnostic questions are resolved by survey X-ray urography, and excretory urography can provide more detailed information (if the patient’s condition allows).

About our clinic Chistye Prudy metro station Medintercom page!

Treatment methods

Removal of stones from the kidneys, bladder and ureter at Best Clinic is performed using gentle methods - contact or extracorporeal lithotripsy.

Contact lithotripsy is the crushing of kidney stones with a holmium laser, while the endoscope is inserted through the urethra into the bladder, and, if necessary, further into the ureter and kidneys, i.e. there is direct contact with the stone. The procedure in our clinic is performed under the control of an innovative low-dose C-arm X-ray machine. Stones in the bladder in men and women, as well as in the ureter and kidneys, disintegrate under the influence of a laser, and the particles are excreted in the urine. The manipulation is performed under general inhalation anesthesia.

External lithotripsy is the treatment of stones in the ureter, bladder and kidneys under the influence of ultrasound passing through intact tissue. Treatment of kidney stones with ultrasound is painless. Sometimes repeated manipulation is required to completely remove stones.

After endoscopic removal of ureteral stones, a hospital stay of 2-4 days is required. During this time, primary restoration of the urinary tract occurs.

Open operations to remove ureteral stones are performed only in advanced cases, when the use of lithotripsy is a priori considered ineffective.

2. Reasons

It should be immediately stipulated that calculi (stones), as well as tumors, are not included in the concept of “foreign body”, although it is advisable not to introduce either one or the other into the genitourinary system, and if they appear (from the inside, we note) - then not launch. A foreign body means an object or substance that has somehow entered the body from the outside. However, the kidneys and ureters, unlike the urethra and even the bladder, are hidden very deeply in the visceral, internal space; they are protected by several layers of dense (though not hard) fabrics.

Accordingly, something very serious must happen for any foreign object to end up in the kidney or ureter.

Indeed, the main “supplier” of such a diagnosis is penetrating bullet, shrapnel, shot wounds (in a combat zone, hunting, in criminal situations), as well as severe industrial and transport accidents. However, with the development of minimally invasive, gentle medical technologies, primarily endoscopic and laparoscopic, it is necessary to mention sporadic cases of iatrogenic, i.e. damage caused by the medical intervention itself, including the introduction of foreign bodies into the upper urinary tract. This probability, we repeat, is extremely small, but still not zero: no one is insured, for example, from a technical defect in the form of an internal crack or cavity in the endoscope material, in the fastening of a catheter-stent (artificial duct), etc. It is ruptures or “slipping” of catheters into the ureter that are sometimes mentioned today as a reason (not the only one, however) for interventions to remove iatrogenic foreign bodies. Some authors also draw attention to the fact that such a stent, designed to ensure unimpeded passage of urine, if left in the ureter for too long, can become clogged with salt deposits, losing conductivity, becoming overgrown with stones and, thus, acquiring the character of an obliterating foreign body - but not immediately, but gradually.

Visit our Urology page

How are strictures (stenoses) of the ureter treated?

Treatment is primarily aimed at restoring the flow of urine. There are several ways to do this, and they are completely different. The choice of one option or another depends on the results of the examination, the condition of the organs, and the size of the stricture.

Important! No traditional medicine methods work for strictures. Do not self-medicate; a traditional hot water bottle is contraindicated in this case. It can cause more urine production, which will lead to more pain.

A summary of possible methods:

Complete plastic surgery – in the most severe cases. This is a serious operation with a difficult rehabilitation period; there is a wide range of contraindications for it.
Bougienage is an outpatient procedure in which the narrowing is moved apart using a bougie - a smooth metal rod. The procedure is quite painful and gives a short-term effect, so it is used extremely rarely in modern hospitals.
Plastic replacement is a surgical intervention for small strictures up to 10-20 mm long. During the operation, the damaged area is excised and replaced with tissue from the patient himself.
Optical urethrotomy is a method in which the abnormal narrowed area is dissected using a cystoscope. Suitable for strictures up to 5 mm. A special spring is implanted into the lumen of the ureter. In this case, the mucous membrane, gradually regenerating, acquires an anatomically correct shape.

Article on the topic: Prevention of hemorrhoids

Tumors of the renal pelvis and ureter

Malignant tumors of the renal pelvis and ureter are rare, accounting for only 4% of malignant tumors of the urinary tract. The average age of patients is 65 years, men get sick 2-4 times more often than women.

Etiology and pathogenesis

Among the risk factors for cancer of the renal pelvis and ureter, as well as bladder cancer, smoking and occupational contact with certain substances (dyes, solvents) should be noted.

In addition, risk factors include analgesic abuse, Balkan endemic nephropathy, and exposure to thorium dioxide, a disused radiocontrast agent called Thorotrast, which was used in the past for retrograde pyelography.

Cancer of the renal pelvis and ureter due to abuse of analgesics is usually observed in young women and is detected in late stages. All components of combined analgesics - paracetamol, aspirin, caffeine and phenacetin - are considered carcinogens.

Pathomorphology

The mucosa of the renal pelvis and ureter is similar to the mucosa of the bladder and is lined with transitional epithelium. As with bladder cancer, the majority of malignant tumors of the upper urinary tract—90% of renal pelvic tumors and 97% of ureteral tumors—are transitional cell carcinoma.

The degrees of differentiation of tumors of the upper urinary tract are the same as for bladder cancer. In approximately 15-20% of cases, tumors of the upper urinary tract turn out to be papillomas. In half of the patients they are single, in another half they are multiple. Most patients do not have metastases at the time of diagnosis. During dissemination, regional lymph nodes, bones and lungs are usually affected.

Approximately 10% of malignant tumors of the renal pelvis are squamous cell carcinoma; in the ureter this tumor is much less common. Squamous cell carcinoma usually appears as a broad-based nodule and is characterized by deep invasion. The history usually includes indications of chronic urinary tract infections or urolithiasis.

Adenocarcinoma of the renal pelvis and ureter is extremely rare. Like squamous cell carcinoma, adenocarcinoma is characterized by deep invasion.

Mesenchymal tumors of the renal pelvis and ureter are very rare. Benign mesenchymal tumors include fibroepithelial polyp (observed most often) and leiomyoma-mangioma. Fibroepithelial polyps are usually detected in young patients.

On X-ray contrast examination, the polyp has the appearance of a narrow, elongated filling defect. The most common malignant mesenchymal tumor is leiomyosarcoma. Tumors of the kidney, ovaries or cervix can grow into the renal pelvis and ureter.

Metastases to the ureter are very rare and occur in stomach, prostate, kidney and breast cancer, as well as in lymphomas.

Staging and prognosis

The stages of renal pelvis and ureter cancer depend on the depth of wall invasion and are similar to the stages of bladder cancer.

The five-year survival rate of patients depends on the stage and degree of differentiation of the tumor: for highly differentiated tumors of early stages it is 60-90%, for poorly differentiated tumors with deep invasion or growing into the retroperitoneal tissue or into the renal parenchyma - 0-33%.

Low survival rate is explained by the high frequency of regional and distant metastases; in stage B (T2) tumors they are observed in 40% of cases, and in stage D (T4) tumors - in 75%.

Clinical picture

Gross hematuria is observed in 70-90% of patients, and less commonly, in 8-50%, low back pain. Pain occurs when the ureter is obstructed by a blood clot or tumor fragments, as well as when the upper urinary tract is obstructed by the tumor itself or is compressed from the outside by metastases to regional lymph nodes. Symptoms of bladder irritation are observed in 5-10% of patients.

General symptoms - loss of appetite, weight loss and weakness - are rare, usually with dissemination. In 10-20% of patients, a space-occupying formation is palpated in the lateral abdomen - an enlarged kidney due to hydronephrosis or a large tumor. Palpation may be painful.

Occasionally, during dissemination, an enlarged liver, supraclavicular or inguinal lymph nodes are palpated.

Laboratory research

A general urine test reveals hematuria. It can be transient, and then it can only be detected with repeated studies. With secondary urinary tract infections, leukocyturia and bacteriuria occur. A small proportion of patients experience changes in biochemical parameters of liver function.

As with bladder cancer, cytological examination of urinary sediment is used in the diagnosis of tumors of the upper urinary tract. In addition, cytological examination of urine obtained from ureteral catheterization or a smear obtained using a brush inserted through an open-tip catheter can be performed.

The sensitivity of cytological examination depends on the degree of tumor differentiation: for highly differentiated tumors it is 20-30%, for poorly differentiated tumors it is 60%. When examining swabs or smears, the sensitivity of the method is higher.

How informative new tests are for tumors of the upper urinary tract, for example, a qualitative test for complement-like protein, is not yet known.

Radiation diagnostics

Pathology is usually detected by excretory urography. Radiographs show a defect in the filling of the renal pelvis or ureter, hydronephrosis, and the upper urinary tract on the affected side may not be contrasted.

Tumors of the upper urinary tract should be differentiated from X-ray negative stones, blood clots, rejected renal papillae, as well as pyeloureterocystosis, fungal infections and tuberculosis. The results of excretory urography are often questionable. In this case, retrograde pyelography is performed.

It allows you to obtain a clearer image of the upper urinary tract and at the same time take material for cytological examination. A radiocontrast agent is administered through a ureteral catheter with an olive-shaped tip. Radiographs reveal a filling defect in the renal pelvis or ureter.

The ureter distal to the tumor is often dilated (a sign of an overturned glass). With X-ray negative ureteral stones, its distal section, on the contrary, is narrowed. The ureteral catheter may become coiled distal to the ureteral tumor (Bergmann's sign). For tumors of the renal pelvis, ultrasound, CT and MRI are informative.

However, these studies usually do not diagnose ureteral tumors, revealing only hydronephrosis. The advantage of ultrasound, CT and MRI is that they can distinguish a tumor and blood clot from an x-ray negative stone. In addition, CT and MRI can diagnose metastases in regional lymph nodes and internal organs.

Ureteropyeloscopy and nephroscopy

Rigid or flexible endoscopes are used to examine the upper urinary tract. They are inserted through the urethra (ureteropyeloscopy) or after puncture of the collecting system (nephroscopy). The ureteropyeloscope is similar to the nephroscope, but has a smaller diameter.

If a malignant tumor is suspected, ureteropyeloscopy is preferable, since with nephroscopy there is theoretically a risk of dissemination of tumor cells along the puncture canal.

Ureteropyeloscopy is indicated to clarify the diagnosis in the presence of a filling defect in the upper urinary tract, when tumor cells are detected during cytological examination, or unilateral gross hematuria in the absence of a filling defect. In addition, ureteropyeloscopy is used in monitoring patients after organ-saving operations for cancer of the renal pelvis or ureter.

Ureteropyeloscopy allows not only to see the tumor, but also to perform a biopsy and various endoscopic interventions, such as electroresection, electrocoagulation or laser coagulation of the tumor. In terms of sensitivity for tumors of the renal pelvis and ureter, endoscopic methods are superior to traditional ones.

Directions for further research

Malignant tumors of the urinary tract are characterized by varying rates of relapses and metastases. Studying the mechanisms of tumor transformation will allow individual treatment planning.

It is possible that indicators such as the rate of proliferation of tumor cells or the expression of certain antigens will be used to assess prognosis. Improving the methods of radiation diagnostics and immunoscintigraphy will make it possible to more accurately determine the stage of the disease and choose treatment.

What place adjuvant and neoadjuvant chemotherapy will take in the treatment of urinary tract tumors will become known after the completion of large clinical trials.

It is necessary to create new antitumor agents for the treatment of patients with disseminated tumors, since the available drugs are not always effective. Studying the mechanisms of resistance to antitumor drugs will improve the effectiveness of treatment.

Source: https://UrologyPro.ru/stati-po-teme/123-opukhol-rak-pochki/258-opukholi-pochechnoj-lokhanki-i-mochetochnika

Etiology and pathogenesis

Etiological factors: contact with aniline dyes, taking analgesics containing phenacetin, Balkan endemic nephropathy (Romania, Bulgaria and the former Yugoslavia), smoking.

Factors contributing to the development of upper urinary tract tumors include previous cystectomy, as well as BCG (Bacillus Calmette-Guérin) therapy for recurrent carcinoma in situ of the bladder.

Metastasis of cancer of the pelvis and ureter occurs not only by hematogenous and lymphogenous routes, but also subepithelially. A manifestation of this pathway of metastasis is the occurrence of metastases in the ureter and bladder. The presence of metastases may also be due to the introduction of tumor cells with urine flow - a descending route of metastasis.

The etiology of epithelial neoplasms of the renal pelvis and ureter includes everything that is already known about the causes of bladder tumors. Occupational tumors of the pelvis (mainly in aniline dye production workers) are much less common than occupational tumors of the bladder.

There is no doubt that, regardless of the type of carcinogenic agents contained in the urine, stagnation of urine plays an important role in the genesis of both occupational and so-called spontaneous tumors of the pelvis.

That is why in the pelvis, where the residence time of urine is calculated in seconds, tumors arise much less frequently than in the bladder, in which urine remains for hours, and in the ureter, which is not a reservoir for urine at all, primary tumors develop even less frequently.

In Bulgaria and Yugoslavia, where tumors of the pelvis and ureter are very common (¾ of all cases of kidney tumor), their occurrence is associated with “Balkan nephropathy,” the endemic foci of which are found in these countries.

Features of the pathogenesis of tumors of the pelvis and ureter are, firstly, the tendency of papillary tumors from the urothelium to malignancy (papilloma steadily turns into cancer); secondly, a tendency to spread along the urinary tract, and only in one direction: from top to bottom, along the flow of urine and contractile activity of the urinary tract.

Epithelial tumors of the urinary tract never spread in the opposite direction: from the bladder to the pelvis. This feature is of great practical importance in the recognition and surgical treatment of urinary tract tumors.

Structure of the ureter

The ureter begins from a narrowed section of the renal pelvis, where urine formed in the kidney flows. Its outlet end ends in the wall of the bladder. In this place, the mucous membrane forms a fold that prevents the reverse flow of urine. The fold works like a valve, since thanks to the muscle fibers it contains it can actively close.

Externally, the ureter has the appearance of a thin tube, which has an outer shell of connective tissue, a middle muscular layer, the fibers of which are intertwined in different directions, and an internal mucous membrane that forms longitudinal folds along the entire length of the ureter.

Part of the ureter is located in the abdominal cavity, and part is located in the pelvic cavity. Along its entire length, segments of narrowing alternate with expansions. On average, the diameter of this organ in the abdominal cavity is from 8 to 15 mm, in the pelvis – up to 6 mm. Significant elasticity allows the ureter to expand when there is difficulty in the outflow of urine up to 8 cm, for example, if there are stones in the ureter. The narrowest point is the exit from the renal pelvis, and this is biologically expedient.

Anatomy of the ureter: structure, functions and possible diseases

The ureter is a paired organ of the urinary system, represented by small ducts up to 30 cm long. The main function is to drain urine from the collecting system (PUS) of the kidney to the ureter. Fluid removal occurs due to wave-like contractions of the muscular layer of the urinary tract. At intervals of 20 seconds, a portion of urine enters the bladder from the kidney.

Location of the ureters

The ureter is a urinary duct with a diameter of up to 7 mm and a length of no more than 30 cm. Designed to distill urine from the renal pelvis to the bladder. From this it is not difficult to conclude how many ureters there are in the body - there are two of them.

Each ureter has 3 sections.

The upper section is located behind the abdomen in the retroperitoneal space. It originates behind the duodenum and adjoins the muscles in the lumbar region. The second section runs next to the colon.

The terminal sections are the most distant from the kidneys. They are located in the thickness of the urea. Their length is no more than 2 cm. Depending on the sequence and location of the departments, urologists distinguish the bladder into three zones - upper, middle and lower.

The symbol for the sections of the urinary ducts is used by doctors when planning and carrying out diagnostic procedures using instruments - catheters, endoscopes.

Structure

The anatomy of the ureter depends on age and gender. It has 3 physiological constrictions:

in the area of exit from the renal pelvis;
at the junction of the pelvic and peritoneal parts of the ureter;
at the junction with the bladder.

The narrowed segments create the squeezing pressure necessary to push urine down the duct. In the area of its connection with the urea there is an orifice. It acts as a valve that prevents the reverse flow of urine.

The ducts have the following sections:

abdominal;
pelvic;
distal (intramural).

The intramural section penetrates the urea and opens in it with a slit-like opening.

The walls of the ureter consist of several layers:

The connective membrane is the outer layer that is not covered by epithelium. Consists of nerve bundles, connective tissue with collagen cells and fibrous structures.
The muscle layer is the middle layer, consisting of muscle fibers. They pass in different directions, providing a wave-like contraction of the ducts. Muscle cells (myocytes) are connected by many bridges of connective tissue.
Mucosa is the inner shell, which is represented by transitional epithelium and collagen fibers. It has a relief in the form of longitudinal folds. They provide rapid stretching of the tubes at the moment of muscle contraction and passage of a portion of urine into the bladder. Muscle fibers grow into the mucous layer. They close the lumen of the urinary tube at the moment of reverse flow of fluid.

The ureter is a multilayered organ capable of instantaneous contraction and expansion. Thanks to this structure, it effectively copes with its main function - the distillation of urine.

Functions in the human body

The urinary ducts perform the function of transporting urine from the renal collecting system to the urinary tract. The paired organ has motor function. Its middle layer, the smooth muscle layer, stimulates the wave-like contraction of the canal. Peristalsis is provided by a pacemaker (pacemaker), which is located in the pelvis zone of the duct.

The rhythm frequency and cyclicity of contractions depend on several factors:

volume of urine excreted by the kidneys;
human physical activity;
presence of pathologies;
body position;
correct functioning of the nervous system.

The urge to contract the walls occurs when a sufficient amount of calcium accumulates in the muscle layer.

Peristalsis

The ureters work in the same way as the intestines. The movement of fluid inside the ducts is ensured by peristalsis. The pacemaker causes the muscles to contract when a sufficient amount of urine accumulates in the renal pelvis. All parts of the organ have autonomy and contract regardless of the peristaltic activity of other parts of the duct.

Mechanism of rhythmic contractions:

the accumulation of urine in the pelvis is accompanied by stretching of the ureteropelvic region, which becomes an impulse for spastic contraction of the wall;
the nerve impulse reaches all parts of the urinary canal, which ensures its wave-like contraction;
circulatory muscles of the ducts drive fluid to the bladder;
the moment urine enters the bladder, the wave-like contractions stop.

A peristaltic wave in the ureter is created at intervals of 15-20 seconds. Timely emptying of the pelvis ensures correct functioning of the kidneys.

Blood supply

The vascular network is located in the outer layer along the entire length of the ureter. It penetrates into the underlying layers of the ureter through capillaries - arterioles and venules. Arterial vessels arise from:

renal artery;
arterial network from the testicular zone in men and the ovarian network in women.

The middle part of the ducts is fed by the peritoneal aorta and iliac artery. The vessels of the iliac artery - the urinary, umbilical and rectal branches - approach the distal part.

The outflow of blood is ensured by the venous vessels of the same name, which are located along the feeding arteries. From the upper part of the ureters, carbon dioxide-saturated blood flows into the testicular/ovarian venous network, and from the lower part into the iliac vein.

Dimensions

The length of the ureter in an adult is 27-34 cm. The length of the urinary tract depends on:

age;
gender;
location of the kidney;
defects of the urinary system.

Normally, the length of the ureter in women is 2-2.5 cm less. The right kidney is located below the left, therefore the length of the canal is 0.8-1 cm less. The width of the ducts in different parts of the ureter varies - 0.2-0.7 cm. The narrowest areas are localized in:

zone of connection of the pelvic and abdominal sections;
the mouth of the renal pelvis;
the junction of the ureter with the bladder.

The diameter of the ureter in women and men is 0.7-0.8 cm. The size of the internal lumen in the area of the abdominal wall is 0.8-1.5 cm. In the pelvis, the canal narrows to 0.6 cm.

The walls of the urinary tract are highly elastic. At the moment of increasing pressure in the renal joint, it can expand to 7-8 cm.

Characteristic features of the ureters

The topographic anatomy of the urinary ducts depends on age and gender. To a greater extent, the differences are associated with the structural features of the reproductive system.

Among women

differences in the anatomy of the urinary canals concern mainly the pelvic region. Otherwise, the paired ducts are formed in exactly the same way as in men. in women they are 25 mm shorter.

Inside the pelvis, the urinary tubes go around the genitals. the upper part is located along the gonads. Not far from the vagina, behind the uterus, the ducts flow into the urea. a muscular sphincter is formed in the area where the organs join.

in men

In men, the ureters are located in the rectum area and reach the vas deferens. They pass past the seminal vesicles to the urea.

It is located in men in the small pelvis next to the seminal vesicles. bubbles separate the urea from the intestines. The ureters connect to the ureter at a slight angle.

its lower part is connected to the prostate, and the upper part remains free and adjacent to the intestinal loop.

in children

The structural features of the urinary canals in children depend on age. In newborns, the length of the ureters does not exceed 7 cm. At the age of 4 years, it is already twice as long. by puberty, the length of the intravesical part of the duct is 1-1.3 cm.

active formation of the organs of the urinary system continues during 1 year of life. due to the underdevelopment of the pelvis and other anatomical structures, the tubes penetrate into the bladder at a right angle.

The muscular layer of the ureters is poorly developed, so pathologies of the urinary system are often detected in children in the first years of life.

pathologies of the ureters

Improper development of the ureter, inflammation and injury to adjacent anatomical structures lead to impaired urine passage. Dysfunction of the urinary tract negatively affects the functioning of the kidneys and urinary tract.

Developmental defects

Congenital diseases of the urinary tract include:

atresia - closure of natural openings, complete or partial absence of sphincters or the canals themselves;
ectopia - abnormal fusion of the ureter with the intestinal wall, seminal vesicles;
megaureter - pathological expansion along the entire length.

Most congenital pathologies are detected in the first years of life. Impaired urine flow leads to decreased kidney function.

Diseases

Acquired urinary tract diseases include:

vesicoureteral reflux – reflux of urine from the bladder back into the ureter and kidneys;
ureterocele - pathological narrowing of the orifice, accompanied by protrusion of the wall of the intravesical section;
Stone obstruction is an obstruction caused by blockage from kidney stones.

In all cases, stagnation of urine is observed, which is dangerous due to kidney dysfunction and poisoning of the body with metabolic products.

Injuries

Trauma to the ureter is accompanied by a violation of the integrity of the walls of the ducts. Closed injuries are rare. They occur when stones pass through the canal. Therefore, the disease occurs more often in people suffering from nephro- or urolithiasis. Sharp stones injure the mucous membrane, causing swelling and obstruction of urine outflow.

In 80% of cases, ureteral injury is associated with a gunshot or knife wound. Depending on the location, injuries can be left-, right-, or bilateral. According to the severity of the damage, incomplete and complete ruptures of the urinary tract are distinguished.

Traumatic damage to the ureters is dangerous due to the release of urine into the surrounding tissues and suppuration.

Neoplasms

Tumors of the ureter - primary and secondary formations in the ducts. Depending on the structure, the following types of pathologies are distinguished:

neurofibroma;
leiomyoma;
lipoma;
papillary adenocarcinoma;
rhabdomyosarcoma.

In 76% of cases, tumors consist of urothelial epithelium. The likelihood of neoplasms increases with diverticula (bag-like protrusions) in the ureter.

Methods for diagnosing problems

To identify diseases of the ureter, various laboratory and instrumental methods are used:

cystoscopy;
ureteral catheterization;
general blood analysis;
ureteroscopy;
overview urogram;
CT scan of the retroperitoneum;
Ultrasound of the kidneys and ureter;
urokymography.

If tumor pathologies are suspected, a cytological examination of urine is performed. In case of disturbance of urine flow, excretory urography with filling of the ureter with a radiopaque solution is recommended.

Symptoms and consequences of dysfunction

Violation of the transport function of the ureter leads to the accumulation of urine in the body and expansion of the kidneys. Pathology is indicated by:

pain in the lower back;
blood impurities in urine;
renal colic;
difficulty urinating;
increased body temperature;
frequent urge to go to the toilet;
signs of intoxication.

The most serious complication is indolent renal failure - an irreversible impairment of kidney function. The disease leads to the decline of organ functions and death of a person.

Potential consequences of urinary tract dysfunction include:

retroperitoneal phlegmon;
acute urinary retention;
hydronephrosis;
peritonitis;
ureterovaginal fistulas;
chronic pyelonephritis;
urohematoma;
urosepsis;
stone formation in the kidneys.

Timely diagnosis and treatment of ureteral diseases prevents dangerous complications. Therefore, if there is a disturbance in urination, pain in the projection of the kidneys, or impurities in the urine, you should immediately contact a urologist.

Source: https://simptom.info/urologiya/mochetochnik-eto

Blood supply

renal artery;
arterial network from the testicular zone in men and the ovarian network in women.

The middle part of the ducts is fed by the peritoneal aorta and iliac artery. The vessels of the iliac artery - the urinary, umbilical and rectal branches - approach the distal part.

Prevention of stenosis

Constrictions do not occur extremely quickly in most cases. In case of trauma, the phenomenon is preceded by extensive retroperitoneal hematomas, which should be drained in a timely manner. Thanks to the professional actions of doctors, in this case, stenosis will not develop and there will be no complications.

Note! The main prevention of ureteral strictures is the timely and correct treatment of all injuries in the lumbar region. A qualified consultation with a urologist in case of blows to the lower back is mandatory, do not neglect it!

What should athletes do if they have such blunt injuries that can be considered a professional phenomenon? Winter sports are dangerous. Many sports disciplines have developed special shields that soften the impact of collisions and impacts.

The prognosis of the disease is positive if the patient complies with all instructions during postoperative rehabilitation. The patient should not assume that ureteral stricture is a one-time occurrence. In most cases, everything depends on the person himself, what kind of life he has, how he views his own safety. Take care of yourself!

Characteristic features of the ureters

The topographic anatomy of the urinary ducts depends on age and gender. To a greater extent, the differences are associated with the structural features of the reproductive system.

Among women

Differences in the anatomy of the urinary canals concern mainly the pelvic region. Otherwise, the paired ducts are formed in exactly the same way as in men. In women they are 25 mm shorter.

Inside the pelvis, the urinary tubes go around the genitals. The upper part is located along the gonads. Not far from the vagina, behind the uterus, the ducts flow into the urea. In the area where the organs join, the muscular sphincter is formed.

In men

The ureters in men are located in the rectum area and reach the vas deferens. They pass past the seminal vesicles to the urea. It is found in men in the small pelvis next to the seminal vesicles. Bubbles separate the urea from the intestines. The ureters connect to the ureter at a slight angle. Its lower part is connected to the prostate, while the upper part remains free and adjacent to the intestinal loop.

In children

The structural features of the urinary canals in children depend on age. In newborns, the length of the ureters does not exceed 7 cm. At the age of 4 years, it is already twice as long. By puberty, the length of the intravesical part of the duct is 1-1.3 cm.

Active formation of the organs of the urinary system continues during 1 year of life. Due to the underdevelopment of the pelvis and other anatomical structures, the tubes penetrate into the bladder at a right angle.

The muscular layer of the ureters is poorly developed, so pathologies of the urinary system are often detected in children in the first years of life.

Causes of ureteral stricture

Urethral stenosis occurs:

congenital and acquired;
single and numerous;
one-sided and two-sided;
true and false.

Note! When pathological changes affect the wall of the ureter, this will be a true stricture. By false they mean narrowings that arise due to compression from the outside - squeezing the walls by various tumors.

Abnormal narrowing of the ureter

Article on the topic: When should you trust Posterizan ointment?

Congenital replacement of mucous membrane with scar tissue occurs due to the presence of hereditary anomalies. Acquired narrowings have various causes depending on their location, most often these are:

Internal injuries - from stones formed in the kidneys. An inflammatory process occurs when the mucous membrane is damaged by a stone and connective tissue is formed.
External injuries - from blunt blows to the lumbar region. In this case, ureteral stricture will occur due to a retroperitoneal hematoma.
Knife and gunshot wounds can also lead to contractions, but these cases are extremely rare.
Damage by a medical instrument during examination or surgery.
Radiation injury, radiation therapy, bedsores.
Inflammation of the ureter, tuberculosis, brucellosis.

If none of the reasons fits the explanation of the development of the anomaly, we can talk about hereditary factors in its occurrence.

Note! The disease most often affects men, since they are more susceptible to various types of injuries in sports, everyday life and work.

Hydronephrosis in a child

Most often, one- or two-sided hydronephrosis occurs in newborns and young children. Sometimes signs of hydronephrosis are detected in a child even before birth during an ultrasound examination of the mother during pregnancy. Surgery performed while the baby is in the uterus or shortly after birth can have good results in improving kidney function.

Sometimes the only symptom of hydronephrosis in children is a higher than usual rate of urinary tract infections. It is important to pay attention to common urinary problems in your child. A urinary tract infection in a newborn baby may indicate a blockage in the kidneys or urinary tract. Older children with frequent recurrent urinary tract infections (cystitis, pyelonephritis) should also be examined for hydronephrosis.

Causes of kidney hydronephrosis

Hydronephrosis is usually caused by another underlying disease or risk factor.

Causes of hydronephrosis include, but are not limited to, the following diseases or risk factors:

kidney stone;
congenital blockage (a defect in the urinary tract that is present at birth);
a clot of blood, mucus, pus;
scars of urinary tract tissue (from injury or previous surgery);
tumor or cancer (such as organs such as the bladder, cervix, colon or prostate);
enlarged prostate in men (non-tumor);
pregnancy in women;
urinary tract infection (or other diseases that cause inflammation of the urinary tract).