ureteral prolapse in children
Introduction
Introduction to pediatric ureteral prolapse Ureterocele is a congenital dysplasia due to congenital stenosis or functional contracture of the ureteral orifice and dysplasia of the ureteral wall, so that the lower end of the ureter forms a bulge that protrudes into the bladder. Therefore, the outer layer of the bulge is the bladder mucosa, and the inner layer is the ureteral mucosa. The thin layer of the ureter is between the two. This disease is often caused by urinary tract obstruction and urinary tract infection. basic knowledge The proportion of illness: 0.001% Susceptible people: children Mode of infection: non-infectious Complications: urinary tract infection uremia
Cause
Pediatric ureteral prolapse
(1) Causes of the disease
In embryogenesis, the ureteral cyst is caused by delayed rupture of the Chwalla membrane. The Chwalla membrane is present in the normal embryo, located between the ureter and the urogenital sinus. The delayed rupture of the membrane leads to the expansion of the terminal ureter, the opening is narrow, and the ureteral orifice position and bulge The relationship is divided into simple type and ectopic type. As shown in Figure 1, the ureteral orifice of the former is slightly offset from the normal position (orthotopic ureterocele). The bulging is often small, and the effect is less. It is more common in adults, also known as adult type. The ureteral bulge is large and complicated with double renal ureteral malformation. The two ureters penetrate the bladder muscle layer at the usual site, the lower ureter ureter opens in the bladder triangle, and the ureter bulges, draining the upper ureter. , located in the submucosal layer, opening in the bladder neck or posterior urethra, clinically also seen between the two types.
(two) pathogenesis
Ectopic ureteral bulging with heavy renal ureter, occurs in the upper kidney ureter of the heavy kidney, the upper kidney is accumulated by back pressure, and often accompanied by pyelonephritis; very common renal dysplasia with fetal kidney Small ball, curved tube and small cyst, which is presumed to be due to severe urinary tract obstruction in the fetal period, so that the upper kidney is immature, and the ipsilateral lower kidney is caused by obstruction and reflux due to the tension of the ureteral bulge. Water accumulation, and large ectopic ureteral bulging occupies the bladder outlet and proximal urethra, it can affect bladder emptying, children have difficulty urinating, but also contralateral kidney, ureteral hydrops.
Prevention
Pediatric ureteral prolapse prevention
This disease is congenital dysplasia, there is no definite preventive measures (refer to the prevention of congenital diseases), in order to reduce the incidence of this disease, prevention should be from pre-pregnancy to prenatal, pre-marital physical examination plays a positive role in the prevention of birth defects, The size of the effect depends on the examination items and content, mainly including serological tests (such as hepatitis B virus, Treponema pallidum, HIV), reproductive system tests (such as screening for cervical inflammation), general physical examination (such as blood pressure, electrocardiogram), and asking about family history of the disease. Personal medical history, etc., do a good job in genetic disease counseling, pregnant women to avoid harmful factors, including away from smoke, alcohol, drugs, radiation, pesticides, noise, volatile harmful gases, toxic and harmful heavy metals, etc., prenatal care during pregnancy The system requires screening for birth defects, including regular ultrasound, serological screening, and, if necessary, chromosomal examination.
Once an abnormal result occurs, it is necessary to determine whether to terminate the pregnancy; the safety of the fetus in the uterus; whether there is sequelae after birth, whether it can be treated, how to prognose, etc., and take practical measures for diagnosis and treatment.
Complication
Pediatric ureteral prolapse complications Complications, urinary tract infection, uremia
Repeated urinary tract infection, can be complicated by stones, ureteral reflux or stagnant water, obstruction does not relieve the final renal failure, leading to uremia.
Symptom
Pediatric ureteral prolapse symptoms common symptoms urinary tract infection, hematuria, urinary dysfunction, repeated fever, lower abdomen, gastrointestinal symptoms, pyuria discharge stones
Ureteral bulging is mainly caused by urinary tract obstruction and infection. It is characterized by repeated fever, pyuria and varying degrees of dysuria, urinary tract interruption, hematuria, and even stones. In infants, there may be growth retardation or non-specific gastrointestinal symptoms. It can also touch the abdomen mass. Because the ectopic ureteral bulge is located in the bladder neck or the posterior urethra, when the girl urinates, part of the bulge can be prolapsed to the outside of the urethra, but occasionally the ureter bulges and forms a Patients with major hemorrhagic masses, such as severe urinary tract obstruction, bilateral renal compression and infection, long-term urinary tract infections and obstruction if not promptly relieved, will lead to loss of renal function, can lead to uremia, especially infants and young children, especially Women with repeated urinary tract infections, dysuria or urethral retractable small masses should be considered, and should be treated with intravenous urography, intravenous urography such as good renal function.
It can be seen that there is a round filling of the ureteral bulge and a relatively thin bulging wall in the bladder. When the upper kidney of the double ureter with the heavy kidney is accompanied by back pressure, water accumulation, infection, dysfunction and no development, the developed The lower kidney is displaced downwards due to pressure and is in a stunted form. At the same time, a round and smooth filling defect is visible in the bladder neck. Sometimes the bulging partial wall is too thin, and the concave appears to be lobulated, cystoscope The examination is easy to identify a round smooth ureter bulging, translucent, covering the normal bladder mucosa, but mostly due to excessive bulging, can not see the whole picture.
Examine
Pediatric ureteral prolapse examination
When complicated by infection or stone, there may be hematuria, white blood cells are obviously increased, peripheral white blood cells are obviously increased, and renal dysfunction such as increased serum creatinine may be present. The diagnosis of ureteral cyst mainly depends on intravenous urography and B-ultrasound examination.
1. Urinary angiography: In urography, the intravesical cyst of a single ureter can be seen as a snake head in the distal ureter, and a circle around it is the ureteral cyst wall. The upper half caused by repeated ureter with ectopic ureteral cyst The kidney is often not developed due to dysfunction, and the lower half of the developed kidney is displaced outwards and downwards, showing a shadow of the lily of the head, and a smooth filling defect is visible at the base of the bladder. This shadow must be differentiated from bladder stones, blood clots, and bladder tumors.
2. B-ultrasound: can detect renal pelvis, ureteral hydrops, intravesical or bladder cysts, can detect cysts above 1cm in the bladder.
3. Cystoscopy: For small cysts, it can be clearly observed. For larger ectopic cysts, a thin wall with blood vessels is seen, and the cysts have rhythmic contraction and filling.
Diagnosis
Diagnosis and diagnosis of pediatric ureteral prolapse
When repeated urinary tract infections must be differentiated from common urinary tract infections, the corresponding imaging examination can be distinguished from common urinary tract infections.
