What is bladder obstruction. Clinical signs of urinary tract obstruction

Structural or functional disorders in the organs responsible for the outflow of urine are a common cause of obstruction. urinary tract. Obstruction is formed at any level from the kidneys to the urethra, more often in places of physiological narrowing. Based on the nature of the occurrence, obstruction of the pathways that excrete urine can be congenital (malformation) and acquired (obstruction or compression).

Obstruction of the urinary systems: classification

The main congenital anomalies that lead to obstruction are:

• bladder neck contracture;
• polyp;
• narrowing of the ureters or urethra (stricture);
• pathological anterior and posterior valves of the urethra;
• protrusion of the wall of the urethra (diverticulum);
• narrowing of the external opening of the urethra (meatostenosis);
• narrowing of the foreskin in men (phimosis);
• infringement of the glans penis by the foreskin ring (paraphimosis).

In the case of acquired disorders, the following reasons are distinguished:

• stones;
• inflammation of the urethra, uterus and its appendages;
• injuries in the pelvic region;
• discharge of necrotic kidney papillae;
• , bladder, urethra or adjacent organs;
• blockage by blood clots;
• cancer of the prostate, bladder, uterus, cervix, colon or colon;
• disruption of work nervous system(diabetic neuropathy);
• spinal cord injury;
• pregnancy;
• seal connective tissue retroperitoneal space (fibrosis);
• expansion of the aorta (aneurysm);
• uterine fibroids;
• prostate adenoma;
• unintentional ligation during surgery.

Manifestations of obstruction are acute or chronic, depending on whether one or both kidneys are affected, unilateral or bilateral. At the same time, both complete and partial blockade urinary tract. So, for young people, kidney stones become a common cause of obstruction, for older people - cancer or a tumor, for children - malformations.

Clinical manifestations

The symptoms of the disease directly depend on the form in which it manifests itself (acute or chronic), on the affected area (unilateral or bilateral) and the degree of obstruction (complete or partial). Chronic obstructive uropathy is characterized by recurrent dull pain in the side, frequent urge to urinate. If only one kidney is damaged, the amount of urine does not decrease. A significant decrease in diuresis indicates bilateral obstruction. Partial obstruction makes it difficult to urinate, the urine stream changes. With complete obstruction, pain increases, nausea and vomiting appear, and body temperature rises.

Intensity pain with obstruction due to the rate of distension of the bladder, ureter or kidney, therefore, when acute form characteristic severe pain that spread to the testicles or vaginal area. The consequence of stretching of the kidney is renal colic, which lasts quite a long time, at short intervals.

Symptoms of the disease are very large, but the following general manifestations can be distinguished:

• pain in the side (on one or both sides, aching or colicky);
• increase in body temperature;
• any discomfort or difficulty urinating;
• nausea, vomiting;
• weight gain (edema);
• changes in diuresis or lack of urine;
• blood in the urine.

Complications

Obstruction of the urinary tract with a complete cessation of the natural movement of urine complicates the work of the kidneys and can cause acute renal failure. Prompt resolution of the obstruction almost always restores normal kidney function. At the same time, untimely detection and elimination of obstruction significantly increase the risk of infection or stone formation, lead to atrophy and chronic renal failure. Obstruction of the urinary tract, caused by a blockage, leads to serious problems in the functioning of the bladder, as a result of which incontinence or urinary retention can become permanent.

Diagnostics

In obstruction, as in any other disease, the effectiveness of treatment and minimization of negative consequences depends on how quickly it was diagnosed. The diagnosis of obstruction of the urinary tract is made based on the results of such tests:

• Biochemical blood test to determine the level of plasma electrolytes, urea nitrogen and creatinine.
• Analysis of urine.
• Catherization of the bladder to determine the patency of the outlet of the bladder or urethra.
• Imaging methods, which are selected depending on the severity and location of the pathological process.

For more information, a gynecological examination for women and a prostate examination for men are prescribed. Imaging examinations help determine the exact location of the blockage and confirm its presence if in doubt. These include:

1. Ultrasound procedure. The method is quite accurate and safe, therefore it is indicated for children and women during pregnancy.
2. An alternative to ultrasound is computed tomography. CT is often used to detect stones and squeezing the organs of the urinary system from the outside with tumors.

If ultrasound and CT do not give an unambiguous result, then other imaging methods are used for clarification, such as:

• cystoureteroscopy (internal examination of the bladder);
• radionuclide scan (assessment of renal function);
• excretory urography (determination of the anatomical and functional state of the kidneys and urinary tract);
• retrograde and anterograde pyelography (obtaining a clear image of the upper urinary tract, pelvis and calyces).

The goal of treating ureteral obstruction is to eliminate it, if possible, or to create a bypass route for urine flow, thus avoiding the development of irreversible kidney damage. Due to the structure of the urinary system, you may need several types of treatment.

Restoration of urine flow
If a ureteral obstruction is causing severe pain, immediate surgery may be needed to remove urine from the body and provide temporary relief. Your doctor (urologist) may recommend:

• Installation of a ureteral stent, which is a hollow tube that is installed inside the ureter to keep its lumen open.
• Percutaneous nephrostomy, a catheter is inserted through an opening in the skin under ultrasound guidance, through which urine is removed from the renal pelvis.
• Bladder catheterization. A catheter, which is a narrow hollow tube, is inserted through the urethra into the bladder. Urine is collected in a urinal. This may be especially important if the cause of the urinary obstruction is related to bladder.

Your doctor will tell you which treatments or combinations of treatments are best for you. Urine drainage may be temporary or permanent, depending on your condition. For example, many people with ureteral obstruction have a ureteral stent or percutaneous nephrostomy when they receive chemotherapy for oncological diseases to make sure that the kidneys are functioning normally during treatment.

Endoscopic surgery
Endoscopic intervention is minimally invasive. An endoscope is inserted through the urethra into the bladder and other parts of the urinary tract. The surgeon makes an incision in the affected area of ​​the ureter and inserts a hollow tube (stent) that keeps the ureter open. Endoscopic interventions can be diagnostic and therapeutic.

Other types of surgical interventions
Surgical procedures to correct ureteral obstruction include:

• Ureterolysis. Ureterolysis (u-re-te-ro-lysis) is an operation to free the ureter from the surrounding abnormal fibrous or scar tissue (adhesions).
• Pyeloplasty. During a pyeloplasty (pi-e-lo-plas-te-ka), the surgeon cuts and removes the affected part of the ureter and inserts a hollow tube (stent) to keep the ureter open. The stent remains in place for six weeks and is removed on an outpatient basis.
• Partial nephrectomy. During a partial nephrectomy, the surgeon removes the damaged part of the kidney caused by an obstruction in the ureter.
• Ureterectomy. In this procedure, the surgeon removes all or part of the ureter, and then reconstructs the urinary tract by moving the kidney down, pulling the bladder up to it, or creating an artificial ureter from other tissues.
• Reimplantation of the ureter. The poorly functioning part of the ureter is removed, and the remaining healthy parts are reattached and resutured to the bladder.
• Transureteroureterostomy. During a transureteroureterostomy (trans-u-re-te-ro-u-re-te-ro-sto-mia), the surgeon attaches one ureter to another. This creates a pathway for urine to flow and prevents damage to the kidneys. The operation is shown urolithiasis or the presence of a malignant tumor.

These surgical interventions can be performed from various approaches:

• Open surgeries, during which the surgeon makes an incision in the abdominal wall to perform the procedure.
• Laparoscopic operations that are performed using special equipment with a light source and a camera. The surgeon makes one or more small incisions in the skin to insert the instruments and cameras necessary for the operation into the abdominal cavity.
• Robotic laparoscopic surgery, in which the surgeon uses a robotic system to perform a laparoscopic procedure.

The main differences between these approaches are the recovery time after surgery and the number and size of incisions used by surgeons. Your doctor (urologist) will determine which type of surgery is best for you.

Medical treatment
Obstruction of the ureter is complicated by a urinary tract infection that requires treatment.

After surgery, your doctor may give you a single dose of antibiotics. Longer course antibiotic therapy required if ureteral obstruction has been complicated by urinary tract infection. Antibiotics may be recommended after removal of a stent or catheter for percutaneous nephrostomy.

If the stent is accompanied by abdominal pain, the doctor may prescribe drugs from the group of alpha-blockers to eliminate this side effect.

In a healthy person, the urinary system consists of two kidneys and the urinary tract (ureters), through which urine enters the bladder, and from there it is excreted through the urethra. The kidneys are paired organs that are located next to the muscles of the human back. They perform an extremely important function of cleansing the body of metabolic products, ions and chemical formations in the blood.

Urine begins to accumulate and form in the kidneys. The ureters are two paired channels that serve to connect the kidneys and the bladder. In our body, the ureters are located parallel to the spine and are thin long tubes (about 12 cm each). In the bladder, urine collects and accumulates. The bladder can hold up to 500 ml of fluid (in women) and up to 800 ml (in men). Then, thanks to the timely reaction of the spinal cord, and then the brain, urine is excreted through the urethra.

The slightest obstruction to the outflow of urine can lead to the formation of stones, infection genitourinary system. However, these diseases are preceded by obstruction of the urinary tract. Urinary tract obstruction is a violation of the natural outflow of urine in the urinary system, which is characterized by high blood pressure in the ureters, bladder, kidneys.

This disease usually occurs in acute and chronic form. Acute obstruction of the urinary tract can cause renal colic, the pain of which can even radiate to the genitals. Chronic obstruction is usually characterized by polyuria (excessive urination) and nocturia (most urine is passed at night).

The causes of urinary tract obstruction can be both physical and mechanical. Among the physical ones, congenital malformations of the urinary tract (too narrow) are distinguished. Mechanical are various obstacles to the natural outflow of urine in the normal structure of the urinary tract. It can be:

• stones in the kidneys;
• prostate cancer;
• BPH;
• hernia;
• trauma;
• infections;
• fecal obstruction;
• blood clots in the urinary tract.

If the mechanical obstruction to the outflow of urine is above the level of the bladder, this can lead to such consequences as hydronephrosis (blockage of the urinary tract), hydroureter (abnormal dilatation of the ureter).

Children may suffer from congenital pathologies of the urinary tract. Among them, retrocaval localization of the ureter is distinguished, which often leads to the development of a disease such as bilateral hydronephrosis. In addition, among the reasons that can cause kidney obstruction (obstructive nephropathy) are:

1. cervical cancer.
2. colon cancer.
3. lymphoma in the retroperitoneum.
4. Ormond's disease.

Danger this disease is that in the first stages it is almost asymptomatic - the patient does not feel the slightest discomfort. At the same time, pressure in the pyelocaliceal system of the kidneys increases intensely, due to which the patient feels renal colic.

Pain in renal colic is so severe that it can be given to the patient's genitals. Over time, the patient's body can adapt to the "improper" functioning of the urinary system: the kidney increases in volume and becomes able to retain more fluid, but its normal operation is disrupted. As a result, the patient may complain of: frequent urination, unexplained increase in pressure.

Diagnostics

If the first symptoms of the disease occur, you should immediately contact a urologist. First, the doctor will begin to collect an anamnesis: learn about the symptoms of the disease, when they began to appear, how often they occur. This is followed by a referral for tests for an accurate diagnosis of the disease:

• Ultrasound of the abdominal cavity;
• urography;
• cystoscopy;
• retrograde pyelography;
• isotope renography;

Ultrasound of the abdominal cavity allows the doctor to see the condition of the patient's organs such as the kidneys, spleen, pancreas, gallbladder, bladder. Ultrasound can detect the presence of kidney stones, pathological changes appearance internal organs, polyps.

Urography includes examination of the entire urinary system: kidneys, ureters, bladder. With obstructive type of urination (this is a decrease in the speed of urine flow), excretory urography is usually used. This type of urography is characterized by the fact that the patient is injected intravenously with a special contrast agent, which includes iodine. Then a series of x-rays are taken. The contrast agent allows you to clearly highlight the organ needed for the study.

Cystoscopy is an examination of the patient's bladder for abnormalities. This procedure is carried out using a special device - a cystoscope. Before carrying out a cystoscopy, the patient is anesthetized to avoid discomfort during it.

Retrograde pyelography is an X-ray examination of the condition of the kidneys. Retrograde pyelography is performed using a cystoscope with a catheter. A contrast agent is also used. The volume of contrast should not exceed the volume of the kidney.
With the help of isotope renography, the kidneys and upper urinary tract are examined. For isotope renography, a patient is injected intravenously with contrast, and then, using a special apparatus, the radiation is monitored.

CT (computed tomography) is the most effective method research using x-rays. A CT scan is done using a tomograph. A significant advantage of CT in comparison with conventional x-rays is that the tomograph takes a number of images, which are then processed using a computer. Then a three-dimensional image of the organ that was examined is modeled. With the help of CT, the doctor is able to accurately determine the pathological development of certain human organs, and then prescribe an effective treatment.

Treatment

Treatment of urinary tract obstruction will be aimed primarily at eliminating obstruction (blockage of hollow organs) in order to avoid unpleasant consequences: sepsis, kidney obstruction. Therefore, the doctor's actions will be aimed at eliminating excess fluid from the organs of the urinary system, which creates dangerous pressure. To do this, catheterize the bladder or ureters (with obstruction of the ureters). After removing excess fluid from the urinary tract, the doctor may prescribe a course of antibiotics to the patient to prevent the development of infectious diseases of the genitourinary system.

If the disease becomes recurrent, surgery may be performed. Surgery is necessary if the patient:

1. urinary retention.
2. recurrent urinary tract infection.
3. sharp pain.
4. progressive kidney failure.

In some cases, radiation therapy is used to eliminate urinary tract obstruction.

Consequences

After the obturation is removed, the flow rate of urine is adjusted naturally. If the patient did not go to the doctor in time, the process may be pathological: acute renal failure occurs, kidney stones may form, infections of the genitourinary system may be recurrent. With prolonged delay in treatment, the patient may develop chronic renal failure.

Urinary tract obstruction in children

This disease in children is congenital and acquired. As a rule, ultrasound can detect the presence of such pathologies in the fetus. However, sometimes when a newborn is examined, the obstruction is no longer detected. However, if the baby was unable to urinate on its own within 24 hours of birth, hydronephrosis may be suspected. An alarming signal may be a weak urine stream in boys.

The diagnosis of urinary tract obstruction in children rarely differs from that in adults. So, diagnostic studies of a child include the following tests:

• Ultrasound of the kidneys;
• voiding cystourethrography;
• uroflowmetry.

A normally functioning urinary system consists of a paired organ - the kidneys, two ureters that connect each kidney to the bladder. Through the urethra, urine is excreted into the external environment. If something begins to interfere with the outflow of urine, obstruction of the urinary tract occurs. This is a very dangerous pathological condition, which is fraught with formidable complications.

Causes

The disease can develop quickly (acute onset) or proceed in a chronic form - a slow course. Pathological condition may extend to one or two sides. The most common causes of obstruction are:

Urolithiasis is one of the most common causes of obstruction

There are a number of other reasons that cause such a condition as obstruction of the bladder neck and other components of the urinary system:

Symptoms

Obstructive processes at the level of the ureter can occur with hidden symptoms. Through an intact channel, urine passes freely into the bladder, and diuresis is maintained in full. There are no primary symptoms, and the visit to the doctor occurs in the later stages of the development of the inflammatory process.

In the pelvicalyceal system, increased pressure may be observed. This leads to hydronephrosis or irreversible renal failure.

If an obstruction is found at the level of the bladder neck, pressure rises and both kidneys are affected.

Pain is the first sign of a disease. The cause of the occurrence is the stretching of the walls of the pyelocaliceal system as a result of excessive pressure of the urine.

If the obstructive process is acute (stone), the pain is very strong, it radiates to the lower abdomen and external genitalia.

In the case of acute obstruction, a pain syndrome similar to renal colic occurs.

If the process has such a course as protracted or chronic, the patient's body begins to adapt to the current situation. On the side of the lesion, the renal tissue is depleted, the pelvis and calyces are enlarged, the nephrons disappear, and the normal functioning of the kidney is disrupted.

After a certain time, the following violations occur:

• there is a violation of urination;
• after urination, urine leakage occurs;
• frequent urge to urinate;
• lack of urine;
• increase in blood pressure.

Obstruction may be suspected if there is a history of urinary tract infections or nephrolithiasis.

The consequences of the obstructive process

If the obstructive process is eliminated in time, there is a sharp and abundant outflow of urine. This is often a physiological process. There is an excess of fluid, urea, sodium excreted from the body.

It is important to remember that with even a slight suspicion of a pathological process occurring in the urinary system, it is urgent to consult a doctor for advice and additional examination. Delay is fraught with serious complications.

Blockage of the ureter

Complete or partial obstruction of the urinary tract is called ureteral obstruction. In most cases, it manifests itself in inflammatory and infectious processes. As well as the advanced stage of obstruction, it causes serious complications of damage to the kidneys and genitourinary system, which can lead to death.

If left untreated, obstruction can lead to kidney dysfunction

What is this pathology?

Problems with the ureter in men are less common, but a serious risk factor is prostate disease, which affects 65% of men.

Obturation of the ureter is the partial or complete cessation of the flow of urine between the kidney and the bladder. The cause of the obstruction is the abnormal narrowing of the pathways and blockage caused by inflammatory or mechanical damage. The work of the genitourinary system consists in the timely removal of fluid and metabolic products of the body.

When the genitourinary system is healthy, after the formation of urine in paired organs (kidneys), it is freely excreted through 2 connecting tubes (ureters) into the bladder, and then out through the urinary tube (urethra). The flow of urine is disrupted due to obstruction, which can happen anywhere in the ureter. The disease responds well to treatment, but if the disease is left unattended, the symptoms quickly increase and lead to serious complications: hydronephrosis, hydrouronephrosis, kidney dysfunction.

Varieties of anomalies determine the causes of occurrence

Obstruction of the ureter is unilateral, rarely bilateral. There are 2 main groups of obstruction:

One of the acquired causes of pathology can be cancer.

Both groups of obstruction may occur due to a genetic predisposition to cancer, the formation of cysts or stones.

How to suspect and confirm the diagnosis?

Symptoms of ureteral obstruction

One of the first symptoms of pathology may be a rise in pressure.

On the early stages the clinical picture is not manifested or gives minor symptoms. Doctors distinguish such manifestations as:

• discomfort;
• increase in temperature and pressure;
• mild form of dysuria;
• pain syndrome in the lumbar region and back.

As the disease progresses, the symptoms increase. clinical picture complement the manifestations of the primary cause of ureteral obstruction, they depend on the etiology of the disease itself. In advanced or acute phases, manifestations such as:

• leakage of urine after urination;
• dysuria;
• sharp pains;
• false urge to urinate.

Diagnostic procedures

Often, the diagnosis of obstruction is made on the basis of ultrasound findings. This examination allows you to identify defects in the early stages. Diagnosis is carried out during pregnancy. So an early diagnosis in the fetus allows you to start treatment on time after birth. The list of examinations for both primary and secondary development of anomalies resort to the following list of diagnostic methods:

Cystoureteroscopy is one of the studies that a patient needs to undergo to make a diagnosis.

• blood and urine tests for general indicators and biochemistry;
• cystoureteroscopy - examination of the urea from the inside;
• Ultrasound, CT and MRI;
• studies with contrast - X-ray, pyelography, kidney scintigraphy, excretory urography;
• voiding cystourethrography - pictures of the urea in the process of emptying;
• gynecological and proctological examination.

Back to index

A set of therapeutic measures for blockage of the ureter

In therapy, a medical and radical method is used. Treatment depends on the characteristics of the disease, severity and distribution. Both methods are mainly aimed at restoring the normal function of the genitourinary system and the functioning of the kidneys. After that, other symptoms are eliminated. In cases of particularly severe diseases such as cancer, treatment is aimed at eliminating the primary disease.

Stones in the kidneys

Stones in the kidneys

Kidney stones are a sign of kidney stones or nephrolithiasis. Practical urology often encounters nephrolithiasis, and kidney stones can form in both children and adults. Among patients with nephrolithiasis, men predominate; stones are more often detected in the right kidney, in 15% of cases bilateral localization of stones occurs.

With urolithiasis. in addition to the kidneys, stones can be found in the bladder (cystolithiasis), ureters (ureterolithiasis), or urethra (urethrolithiasis). Almost always, stones initially form in the kidneys and from there descend into the lower urinary tract. There are single calculi and multiple; small kidney stones (up to 3 mm) and large ones (up to 15 cm).

The process of stone formation and types of stones

The formation of kidney stones occurs as a result of a complex physicochemical process in violation of the colloidal balance and changes in the renal parenchyma.

Under certain conditions, a so-called elementary cell, a micelle, is formed from a group of molecules, which serves as the initial nucleus of the future calculus. The “building” material for the nucleus can be amorphous sediments, fibrin threads, bacteria, cellular detritus, foreign bodies present in the urine. Further development the process of stone formation depends on the concentration and ratio of salts in the urine, the pH of the urine, the qualitative and quantitative composition of the urinary colloids.

Most often, stone formation begins in the renal papillae. Initially, microliths form inside the collecting ducts, most of which do not stay in the kidneys and are freely washed out by urine. When the chemical properties of urine change (high concentration, pH shift, etc.), crystallization processes occur, leading to retention of microliths in the tubules and encrustation of papillae. In the future, the stone may continue to "grow" in the kidney or descend into the urinary tract.

According to the chemical composition, several types of stones found in the kidneys are distinguished - oxalate, phosphate, urate, carbonate, cystine, protein, cholesterol, xanthine. Oxalates are composed of calcium salts of oxalic acid. They have a dense structure, black-gray color, prickly uneven surface. Oxalate kidney stones can form in both acidic and alkaline urine.

Phosphates are calculi consisting of calcium salts of phosphoric acid. By consistency, they are soft, crumbling, with a smooth or slightly rough surface, whitish-grayish in color. Phosphate kidney stones are formed with alkaline urine, they grow quite quickly, especially in the presence of infection (pyelonephritis).

Urates are represented by crystals of salts of uric acid. Their structure is dense, the color is from light yellow to brick red, the surface is smooth or finely punctate. Urate kidney stones occur when the urine is acidic. Carbonate stones are formed during the precipitation of calcium salts of carbonic (carbonate) acid. They are soft, light, smooth, can have a different shape.

Cystine stones contain sulfur compounds of the amino acid cystine. Calculi have a softish consistency, smooth surface, rounded shape, yellowish-white color. Protein stones are formed mainly by fibrin with an admixture of bacteria and salts. These kidney stones are soft, flat, small in size, white in color. Cholesterol kidney stones are rare; formed from cholesterol, have a soft crumbling texture, black color.

Sometimes in the kidneys, stones are formed not of a homogeneous, but of a mixed composition. One of the most difficult variants of nephrolithiasis are staghorn kidney stones, which make up 3-5% of all calculi. Coral-like kidney stones grow in the pelvis and in appearance represent its cast, almost completely repeating the size and shape.

Reasons for the formation of kidney stones

Stone formation is based on the processes of crystallization of urine saturated with various salts and the deposition of crystals on the protein matrix-core. Kidney stone disease can develop in the presence of a number of concomitant factors.

Violation of mineral metabolism, leading to the formation of kidney stones, may be genetically determined. Therefore, people with a family history of nephrolithiasis are advised to pay attention to the prevention of stone formation, early detection of calculi by monitoring a general urine test. passage of ultrasound of the kidneys and ultrasound of the bladder. observation by a urologist.

Acquired disorders of salt metabolism, leading to the formation of kidney stones, may be due to external (exogenous) and internal (endogenous) causes.

Among the external factors, the greatest importance is given to climatic conditions and the drinking regime and diet. It is known that in hot climates with increased sweating and a certain degree of dehydration of the body, the concentration of salts in the urine increases, which leads to the formation of kidney stones. Dehydration of the body can be caused by poisoning or an infectious disease that occurs with vomiting and diarrhea.

In the northern regions, the factors of stone formation can be a deficiency of vitamins A and D, a lack of ultraviolet radiation, the predominance of fish and meat in the diet. The use of drinking water with a high content of lime salts, food addiction to spicy, sour, salty also leads to alkalization or acidification of urine and precipitation from salts.

Among the internal factors contributing to the formation of kidney stones, in the first place, hyperfunction of the parathyroid glands is distinguished - hyperparathyroidism. The increased work of the parathyroid glands increases the content of phosphates in the urine and the leaching of calcium from the bone tissue. At the same time, the concentration of calcium phosphate salts in the urine increases significantly. Similar disorders of mineral metabolism can occur in osteoporosis. osteomyelitis. bone fractures, spinal cord injuries, spinal cord injuries. accompanied by prolonged immobility of the patient, rarefaction of bone tissue, impaired dynamics of urinary tract emptying.

Endogenous factors in the formation of kidney stones also include diseases of the gastrointestinal tract - gastritis. peptic ulcer. colitis. leading to a violation of the acid-base balance, increased excretion of calcium salts, a weakening of the barrier functions of the liver and a change in the composition of the urine.

In the pathogenesis of the formation of kidney stones, a well-known role belongs to unfavorable local conditions in the urinary tract - infections (pyelonephritis, nephrotuberculosis, cystitis, urethritis), prostatitis. kidney anomalies. hydronephrosis. prostate adenoma. diverticulitis and other pathological processes that disrupt the passage of urine.

Slowing down the outflow of urine from the kidney causes stagnation in the pyelocaliceal system, oversaturation of urine with various salts and their precipitation, delay in the excretion of sand and microliths with urine. In turn, the infectious process that develops against the background of urostasis leads to the ingress of inflammatory substrates into the urine - bacteria, mucus, pus, and protein. These substances are involved in the formation of the primary nucleus of the future calculus, around which salts crystallize, which are present in excess in the urine.

Symptoms of kidney stones

Depending on their size, number and composition, kidney stones can cause symptoms of varying severity. A typical clinic of nephrolithiasis includes back pain, the development of renal colic. hematuria, pyuria, sometimes - independent discharge of a stone from the kidney with urine.

Pain in the lower back develops as a result of a violation of the outflow of urine, can be aching, dull, and with an abrupt onset of urostasis, with blockage of the pelvis of the kidney or ureter by a stone, progress to renal colic. Coral-like kidney stones are usually accompanied by a mild dull pain, while small and dense ones give a sharp paroxysmal pain.

A typical attack of renal colic is accompanied by sudden sharp pains in the lumbar region spreading along the ureter to the perineum and genitals. Reflexively, against the background of renal colic, frequent painful urination, nausea and vomiting, and flatulence occur. The patient is agitated, restless, cannot find a posture that alleviates the condition. The pain attack in renal colic is so pronounced that it is often stopped only by the introduction of narcotic drugs. Sometimes with renal colic develops oliguria and anuria, fever.

At the end of an attack of renal colic, sand and stones from the kidneys often leave with urine. When passing stones, they can injure the urinary tract mucosa, causing hematuria. More often, mucosal damage is caused by pointed oxalate calculi. With kidney stones, the intensity of hematuria can be different - from slight erythrocyturia to severe gross hematuria. The excretion of pus in the urine (pyuria) develops when there is inflammation in the kidneys and urinary tract.

The presence of kidney stones is not symptomatic in 13-15% of patients. In this case, as a rule, pyelonephritis and morphological changes in the kidneys are absent.

Diagnosis of kidney stones

Recognition of kidney stones is made on the basis of anamnesis, a typical picture of renal colic, laboratory and instrumental imaging studies.

At the height of renal colic, a sharp pain is determined on the side of the affected kidney, a positive symptom of Pasternatsky, pain on palpation of the corresponding kidney and ureter. Urinalysis after an attack reveals the presence of fresh red blood cells, white blood cells, protein, salts, bacteria. A biochemical study of urine and blood to a certain extent allows us to judge the composition and causes of the formation of kidney stones.

Right-sided renal colic must be differentiated from appendicitis. acute cholecystitis. in connection with which it may be necessary to perform an ultrasound of the abdominal cavity. With the help of ultrasound of the kidneys, anatomical changes in the organ, the presence, localization and movement of stones are evaluated.

The leading method for detecting kidney stones is x-ray diagnostics. Most of the calculi are already determined during survey urography. However, protein and uric acid (urate) kidney stones do not block rays and do not give shadows on survey urograms. They are subject to detection using excretory urography and pyelography. In addition, excretory urography provides information on morphological and functional changes in the kidneys and urinary tract, localization of stones (pelvis, calyx, ureter), shape and size of kidney stones. If necessary, the urological examination is supplemented by radioisotope nephroscintigraphy. MRI or CT of the kidneys.

Treatment of kidney stones

Treatment of nephrolithiasis can be conservative or operative and in all cases is aimed at removing stones from the kidneys. elimination of infection and prevention of re-formation of calculi.

With small kidney stones (up to 3 mm), which can be removed independently, an abundant water load and a diet that excludes meat and offal is prescribed. With urate stones, a milk-vegetable diet is recommended, alkalizing urine, alkaline mineral waters (Borjomi, Essentuki); with phosphate stones - intake of acidic mineral waters (Kislovodsk, Zheleznovodsk, Truskavets), etc. Additionally, under the supervision of a nephrologist, they can be used medications, dissolving kidney stones, diuretics, antibiotics, nitrofurans, antispasmodics.

With the development of renal colic, therapeutic measures are aimed at relieving obstruction and pain attack. For this purpose, injections of platifillin, metamizole sodium, morphine or combined analgesics in combination with atropine solution are used; a warm sitz bath is performed, a heating pad is applied to the lumbar region. With non-stopping renal colic, a novocaine blockade of the spermatic cord (in men) or a round ligament of the uterus (in women), catheterization of the ureter or dissection of the mouth of the ureter (if the calculus is infringed) is required.

Surgical removal of stones from the kidneys is indicated for frequent renal colic, secondary pyelonephritis, large stones, ureteral strictures. hydronephrosis, blockade of the kidney, threatening hematuria, single kidney stones, staghorn stones.

In practice, with nephrolithiasis, a non-invasive method is often used - remote lithotripsy. allowing to avoid any intervention in the body and remove fragments of stones from the kidneys through the urinary tract. In some cases, an alternative to open surgery is a high-tech procedure - percutaneous (percutaneous) nephrolithotripsy with lithoextraction.

Open or laparoscopic interventions to remove stones from the kidneys - pyelolithotomy (dissection of the pelvis) and nephrolithotomy (dissection of the parenchyma) are resorted to in case of ineffectiveness of minimally invasive surgery. With a complicated course of nephrolithiasis and loss of kidney function, nephrectomy is indicated.

Prediction and prevention of kidney stones

In most cases, the course of nephrolithiasis is prognostically favorable. After removal of stones from the kidneys, subject to the instructions of the urologist, the disease may not recur. In adverse cases, calculous pyelonephritis and symptomatic hypertension may develop. chronic renal failure. hydropyonephrosis.

For all types of kidney stones, it is recommended to increase the volume of drinking up to 2 liters per day; the use of special herbal preparations; exclusion of spicy, smoked and fatty foods, alcohol; exclusion of hypothermia; improvement of urodynamics through moderate physical activity and exercise. Prevention of complications of nephrolithiasis is reduced to the early removal of stones from the kidneys, the mandatory treatment of concomitant infections.

Kidney stones (urolithiasis), causes, symptoms, treatment, prevention of kidney stones

kidney stones video

Urolithiasis is a disease of the kidneys and urinary tract, characterized by the formation of stones (calculi) in the kidneys and urinary tract stones. Therefore, this disease is called nothing more than kidney stones.

Urolithiasis or nephrolithiasis is the medical term used to describe stones that form in the urinary tract.

The urinary tract, or system, consists of the kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs located below the ribs in the middle of the back, one on each side of the spine. The kidneys remove excess water and waste from the blood by participating in the production of urine. They also maintain a stable balance of salts and other substances in the blood. The kidneys produce hormones that help build strong bones and red blood cells.

Doctors also use terms that describe the location of stones in the urinary tract. For example, when stones are found in the ureter, the term ureterolithiasis is used, the presence of stones anywhere in the urinary tract is called urolithiasis, stones directly in the renal pelvis are called nephrolithiasis.

Kidney stones, one of the most painful of the urological disorders that people have suffered for centuries. Scientists have found evidence of this by finding kidney stones in a 7,000-year-old Egyptian mummy. Unfortunately, kidney stones are one of the most common urinary tract diseases.

Kidney stones are hard masses made up of tiny crystals. At the same time, there may be one or more stones in the kidney or ureter, and they form when the urine becomes too concentrated and substances in the urine crystallize to form stones. Symptoms occur when stones begin to move down the ureter, causing severe pain.

Causes and risk factors for kidney stones

- Dehydration. Dehydration as a result of reduced fluid intake or physical activity without adequate fluid replacement increases the risk of kidney stones. A blockage in the flow of urine can also lead to the formation of stones. In this regard, the climate may be a risk factor for the development of kidney stones, since residents of hot and dry areas are more likely to experience dehydration and are susceptible to the formation of kidney stones.

- Chronic urinary infection. Kidney stones can also result from infections in the urinary tract, such as pyelonephritis and cystitis.

- Metabolic disease. Metabolic disorders, including hereditary metabolic disorders, can change the composition of urine and increase a person's risk of stone formation.

- Violation of calcium metabolism in the body - hypercalciuria. Other hereditary disease, characterized by high calcium in the urine, causes stones in more than half of the cases. In this condition, too much calcium is absorbed from food and excreted in the urine, where it can form calcium phosphate or calcium oxalate stones.

- Gout. Gout causes a chronic increase in the amount of uric acid in the blood and urine, which can lead to the formation of uric acid stones.

- Anomalies in the development of the kidneys and kidney disease. People suffering from hyperparathyroidism, renal tubular acidosis, cystinuria and hyperoxaluria, narrowing of the ureter, anomalies in the development of the kidneys, and polycystic kidney disease have an increased risk of kidney stones.

- Diabetes and hypertension. chronic diseases, such as diabetes and high blood pressure, are also associated with an increased risk of kidney stones.

- Diseases of the digestive tract. People with inflammatory bowel disease are also more likely to develop kidney stones due to impaired calcium metabolism and to increase the concentration of stone-forming substances in the blood. Those who have undergone an intestinal bypass or stoma are also at an increased risk of kidney stones.

- Taking medication. Some drugs also increase the risk of kidney stones. These drugs include some diuretics, calcium-containing antacids, and protease inhibitors indinavir, a drug used to treat HIV infection.

- Nutrition. Dietary factors may increase the risk of stone formation in susceptible individuals, including high animal protein intake, high salt content, excessive sugar intake, excess vitamin D, and possibly excessive consumption of oxalate-containing foods such as spinach.

- Hypodynamia. A sedentary lifestyle and mainly sedentary work leads to a violation of phosphorus-calcium metabolism and congestion in the small pelvis, which in turn causes the formation of stones in the urinary system.

Types of kidney stones

Kidney stones form when urine contains too much of certain substances. These substances can create small crystals that become stones. Stone formation can take weeks or months. There are different types of kidney stones:

— Calcium stones (wedellite, wevellite, apatite, brushite, whitlockite). Calcium kidney stones are the most common. They are more common in men in their 20s and 30s. Calcium usually combines with other substances such as oxalates, phosphates, or carbonates to form stones. Oxalates are present in some foods such as spinach. They are also found in vitamin C supplements. small intestine increase the risk of developing these stones. Interestingly, low levels of dietary calcium can lead to altered calcium oxalate balance and lead to increased oxalate excretion and a tendency to form oxalate stones.

- Cystine or protein stones. Cystine is a substance that is integral part muscles, nerves and other parts of the body. Cystine stones can form in people who are prone to cystinuria. This disease is inherited and affects men and women equally.

- Magnesium stones (newberite, struvite). Struvite is mostly found in women who have urinary tract infections. These stones can be very large and can block the kidneys, ureters, or bladder.

- Uric acid stones (sodium urate, ammonium urate). Urates are more common in men than in women. They can occur with gout or chemotherapy.

— Mixed stones. Other substances, including drugs such as acyclovir, indinavir, and triamterene, can also form stones.

Symptoms of kidney stones (kidney stones)

Kidney stones are usually asymptomatic until the stones move down the ureters and into the bladder. When this happens, stones can block the flow of urine from the kidney.

The main symptom is severe pain that starts suddenly and can stop just as abruptly. This pain has been described by many as the worst pain of their lives, even worse than the pain of childbirth or broken bones.

The main symptoms of urolithiasis usually include:

- Pain in the abdomen or lower back, called renal colic. It can be so severe that it is often accompanied by nausea and vomiting and may radiate to the groin, thigh, or testicle.

Kidney stones: symptoms, treatment

The most urgent task of modern urology is the problem of treatment of urolithiasis. To date, this pathology remains one of the causes of renal failure (about 7% of patients requiring hemodialysis are patients with KSD). The annual incidence rate of nephrolithiasis increases every year and leads to the development of various complications, and the results of treatment do not always satisfy their effectiveness.

Urolithiasis, in clinical terminology called nephrolithiasis, is a polyetiological metabolic disease, manifested by the formation of stones (stones) in the kidneys. This pathology, characterized by a tendency to relapse and a severe persistent course, is often hereditary.

Today, there are many theories explaining the causes of stone formation, but none of them can be considered completely true and well-established. According to experts, there are endogenous and exogenous factors that provoke the development of nephrolithiasis.

Endogenous factors

• hereditary predisposition;
• Increased absorption of calcium in the intestine;
• Increased mobilization of calcium from bone tissue (impaired bone metabolism);
• Anomalies in the development of the urinary system;
• Infectious and inflammatory processes;
• Disorders of uric acid metabolism and purine metabolism;
• Violation of the function of the parathyroid glands;
• Pathology of the digestive tract;
• Some malignant diseases;
• Prolonged bed rest due to injuries or severe somatic diseases.

Exogenous factors

• Foods high in animal protein;
• Prolonged fasting;
• Excessive consumption of alcohol and caffeine;
• Uncontrolled use of antibiotics hormonal drugs, diuretics and laxatives;
• Hypodynamia (cause of violation of phosphorus-calcium metabolism);
• Geographical, climatic and housing conditions;
• Type of professional activity.

Classification of kidney stones

Mineralogical classification

• The most common group of stones (70% of the total) are inorganic compounds of calcium salts (calcium oxalate and calcium phosphate stones). Oxalates are formed from oxalic acid, phosphates from apatite.
• stones infectious nature(15-20%) - magnesium containing stones.
• Uric acid stones, or urates (calculi consisting of salts of uric acid). Make up 5-10% of the total.
• Protein stones that occur in 1-5% of cases due to a violation of amino acid metabolism.
• Cholesterol stones (soft black stones that are not visible on x-rays).

It should be noted that isolated forms of nephrolithiasis are quite rare. More often stones have a mixed (polymineral) composition.

In the event that the origin of nephrolithiasis is associated with dietary habits and the composition of drinking water, primary nephrolithiasis is diagnosed. This disease is caused by persistent acidification of urine, excessive intestinal absorption of metabolites, and decreased renal reabsorption.

In pathologies accompanied by metabolic disorders (hyperkalemia, hypercalcemia, hyperuricemia), we are talking about secondary nephrolithiasis.

Localization, size and shape

Stones can be localized in one or both kidneys (in the renal pelvis, as well as in the lower, middle or upper calyx). They are single and multiple. The sizes of stones, indicated in millimeters (<5, >20), can vary from a pinhead to the size of the renal cavity (staghorn stones are able to form a cast of the pelvicalyceal system). The shape of the kidney stones can be round, flat or angular.

Mechanism of formation of kidney stones

The mechanism of origin and development of nephrolithiasis depends on various factors (urine pH, type of diathesis, excretion of one or another type of salt, etc.). According to experts, the primary formation of stones occurs in the renal pelvis and collecting ducts. First, a nucleus is formed, and then crystals begin to form around it.

There are several theories of stone formation (crystallization, colloid and bacterial). Some authors note that atypical gram-negative bacteria capable of producing apatite (calcium carbonate) play a major role in the process of nucleus formation. These microorganisms are found in 97% of all renal calculi.

Most often, nephrolithiasis is diagnosed in males. At the same time, women are characterized by more severe forms of pathology (for example, staghorn calculi, which occupy almost the entire cavity system of the excretory organ).

Due to the fact that kidney stones are a polyetiological disease, before developing a treatment strategy, it is necessary to try to find out the cause of the development of the pathological process.

• Sometimes nephrolithiasis is almost asymptomatic, that is, a person can find out about his disease only if the stone passes during urination. However, more often the discharge of the calculus is accompanied by pains of varying intensity that occur when it moves along the urinary tract (the so-called renal colic). Localization of pain can be different (it depends on the level of fixation of the stone). If the stone lingers immediately upon exiting the kidney, patients complain of pain in the lower back (on the right or left side). With a delay in the calculus in the ureter, pain can be given to the genitals, lower abdomen, inner thigh, or localized in the navel.
• Hematuria (the appearance of blood in the urine) is the second most important symptom of urolithiasis. Sometimes the amount of blood released is insignificant (microhematuria), and sometimes it is quite plentiful (macrohematuria). In the latter case, urine acquires the color of meat slops. The development of bleeding is explained by the fact that when the calculus moves along the urinary tract, the soft tissues of the kidneys and ureters are injured. It should be noted that blood in the urine appears after an attack of renal colic.

1. Dysuria (impaired urination). Problems with urination (urgency and obstructed outflow of urine) occur when the calculus passes through the bladder and urethra. In the case when the stone completely blocks the exit from the bladder into the urethra, the development of anuria (complete absence of urine) is possible. Urostasis of the kidneys (impaired urine outflow) is a rather dangerous condition that can lead to the development of an acute inflammatory process (pyelonephritis), which is one of the complications of nephrolithiasis. This condition is accompanied by an increase in body temperature up to 39-40 C and other symptoms of general intoxication.

With pelvic nephrolithiasis, caused by the formation of small stones in the renal pelvis, the disease is characterized by a recurrent course, accompanied by repeated attacks of excruciating pain arising from acute obstruction of the urinary tract.

Coral-shaped (pyelocaliceal) nephrolithiasis is quite rare, but at the same time, the most severe form of nephrolithiasis caused by a stone that occupies more than 80% or the entire pelvicalyceal system. Symptoms of this condition are periodic pain of low intensity and episodic gross hematuria. Gradually, pyelonephritis joins the pathological process and chronic renal failure slowly develops.

Diagnosis of nephrolithiasis

Diagnosis of nephrolithiasis includes the following activities:

2. collection of anamnesis (information about past diseases, the development of the disease, living conditions, etc.);
3. laboratory examination of blood and urine (with the obligatory determination of the level of calcium, phosphates, oxalates and uric acid in the blood and bacteriological analysis of urine);
4. ultrasound examination of the kidneys;
5. survey and excretory urography.

According to medical indications, magnetic resonance imaging or computed tomography with intravenous contrast can be performed.

In the case of independent discharge of the calculus, a study of it is carried out. chemical composition.

In the process of preoperative preparation, the patient needs to consult an anesthesiologist, therapist and other highly specialized specialists.

Kidney stones: treatment

Conservative therapy

Conservative treatment of nephrolithiasis is aimed at correcting metabolic disorders that lead to the formation of kidney stones, their independent removal and elimination of the inflammatory process. The complex of therapeutic measures includes:

6. diet therapy;
7. correction of water and electrolyte balance;
8. physiotherapy;
9. antibacterial therapy;
10. phytotherapy;
11. physiotherapy;
12. balneological and spa treatment

Diet and drinking regimen for nephrolithiasis

When prescribing a diet, first of all, the chemical composition of the removed stones and the nature of metabolic disorders are taken into account. General dietary recommendations include diversity and at the same time the maximum restriction of the total volume of food and the use of a sufficient amount of fluid (the daily volume of urine excreted should reach 1.5-2.5 liters). As a drink, it is allowed to use pure water, cranberry and lingonberry fruit drinks and mineral water. At the same time, foods rich in stone-forming substances should be limited as much as possible.

Medical therapy

Drug therapy aimed at correcting metabolic disorders is prescribed on the basis of diagnostic examination data. Treatment is carried out in courses, under strict medical supervision. In all forms of nephrolithiasis, anti-inflammatory, diuretic, stone expelling, analgesic and antispasmodic drugs. Antibacterial therapy is also carried out, it is recommended to take antiplatelet agents, angioprotectors and herbal preparations.

After percutaneous nephrolitholapaxy, remote lithotripsy of open surgery, instrumental or independent stone removal, a course of drug therapy is also carried out. The duration of treatment is set purely individually, in accordance with medical indications and general condition patient.

Physiotherapy treatment

Physiotherapeutic treatment of nephrolithiasis, aimed at normalizing metabolic processes, relaxation smooth muscle urinary system and elimination of inflammation, includes ultrasound, laser therapy and analgesic effect various kinds impulse current.

Phytotherapy

To date, the only possible way of long-term impact on the human body in the medical correction of urolithiasis is herbal treatment. Individual herbs can be used as raw materials, herbal preparations, as well as phytopreparations made on their basis. Medicines vegetable origin should be selected by a specialist, depending on the chemical composition of the calculus. Such drugs have a diuretic and anti-inflammatory effect, are able to destroy and remove kidney stones, as well as stabilize metabolic processes in the body.

Spa treatment

This method of treatment of nephrolithiasis is prescribed both in the presence of a stone and after its removal. It should be noted that spa treatment has its limitations (it is carried out if the diameter of the stones does not exceed 5 mm). In the presence of urate, oxalate and cystine stones, patients are sent to resorts with alkaline mineral waters (Kislovodsk, Zheleznovodsk, Essentuki, Pyatigorsk). Phosphate stones are treated with acidic waters of mineral origin (Truskavets).

Crushing and removal of stones

To date, the main direction of treatment of nephrolithiasis is the crushing and removal of stones from the kidneys. This applies to stones larger than 5 mm.

Note: this technique does not eliminate the cause that provoked the formation of stones, and therefore, after their removal, re-stone formation is possible.

Remote lithotripsy

Remote impact on the calculus by the shock wave method involves the use of a special apparatus (lithotriptor). Depending on the modification of the device, a powerful ultrasonic or electromagnetic wave easily and painlessly overcomes soft tissues and has a crushing effect on a solid foreign body. First, the stone is broken into smaller fractions, after which it is freely excreted from the body.

Remote lithotripsy is a fairly effective and relatively safe method of treatment, through which a rapid therapeutic effect is achieved. Immediately after the procedure, stones are excreted during urination. Subsequently, the patient may continue drug treatment at home.

Laser lithotripsy

Laser crushing is the most modern and safest method used in the presence of stones of various sizes in the kidneys. The procedure uses a nephroscope inserted through the urethra. Through it, a laser fiber is fed to the kidney, which turns stones into fragments, the size of which does not exceed 0.2 mm. Further, the sand is freely excreted along with the urine. It should be noted that this is a minimally invasive, absolutely painless procedure that can be used even when removing staghorn stones.

Transurethral urethrorenoscopy

In urological practice, this technique is used to remove stones small size located in the kidney, ureter, bladder or urethra. The procedure is performed on an outpatient basis, i.e. does not require hospitalization. The stone is crushed or removed using a ureteroscope inserted into the ureter or a nephroscope inserted directly into the kidney. It should be noted that this is a rather traumatic technique that requires high professionalism and extensive experience from the urologist.

Percutaneous contact nephrolitholapaxy

This technique, which involves crushing and extracting a kidney stone using a nephroscope, is used if the size of the formation exceeds 1.5 cm. kidney segment. A nephroscope is inserted through it and miniature surgical instruments are used to crush and remove stones.

Removal of stones surgically

Currently, surgical removal of kidney stones, due to the high invasiveness of open surgery, is carried out strictly according to medical indications. This method removes large stones that clog the urinary ducts, or completely fill the pelvicalyceal system. At the same time, surgical intervention can be prescribed for chronic pyelonephritis that has developed against the background of nephrolithiasis, with the ineffectiveness of lithotripsy, and also with gross hematuria.

In conclusion, it is necessary to pay attention to the fact that in the presence of kidney stones, none medical technique cannot be used separately from others, that is, this disease requires an integrated approach to treatment. Within 5 years after the removal of stones, the patient must be under dispensary observation, periodically undergo diagnostic procedures and a course conservative therapy aimed at correcting metabolic disorders and eliminating infection.

When urine is not fully excreted, it accumulates in the organs of the urinary system and kidneys, then obstruction of the ureter is diagnosed. The problem of organ blockage is associated with various reasons, including congenital ones. Pathology needs timely elimination, because over time it leads to complications, the patient experiences pain. In an advanced case, obstruction of the ureters provokes renal failure, sepsis. If timely action is not taken, a person is at risk of death.

general information

The main function of the urinary system, in particular the ureters, is to remove metabolic products and fluid that has accumulated in the body. A healthy person has two tubes through which urine is excreted. If obstruction of one ureter is diagnosed, then urine is not able to be excreted through one of them. As a result, it accumulates in the body. Influence on the blockage of the ureter can be internal and external sources.

Main reasons

The causes of ureteral obstruction are pathologies of the congenital or acquired type. In most cases, congenital defects are diagnosed that have affected the abnormal development of the urinary system. Abnormal phenomena in the development of the urinary system include the following factors:

• double ureter;
• blockage in the ureteropelvic segment;
• ureterocele;
• obstruction in the vesicoureteral segment.

In the case of obstruction of the vesicoureteral segment, there is a blockage at the junction of the ureter with the bladder. With such a pathology, urine is thrown into the kidneys, inflammation develops. If a ureterocele is diagnosed, then the lumen of the ureter narrows due to a cyst or hernia that protrudes the walls of the organ. In most cases, the pathological process is localized near the bladder, which prevents the normal excretion of urine. Pathology leads to the reverse reflux of urine into the kidneys.

With obstruction of the ureteropelvic segment, the patency in the ureter in the region of the renal pelvis is impaired. Pathology is marked by stagnation of urine, leading to expansion and enlargement of the kidney. If the problem is not corrected in time, organ dysfunction will occur. As a rule, such a pathology is diagnosed in childhood or is congenital.

The most common cause that leads to obstruction is a duplication of the ureter. Pathology is characterized by the departure of two ureters from one kidney. It is extremely rare that both ureters function normally, in most cases the second organ is underdeveloped. If the two ureters work normally, then the urine returns to the organ and injures the kidney.

Internal and external obstruction

Causes of internal and external obstruction are various diseases and deviations. Often, blockage of the ureter is associated with the formation of stones in the organ. If a person suffers from constant constipation, then the likelihood of obstruction increases. For this reason, pathology is often diagnosed in children. Neoplasms of a malignant or benign nature can affect the disease.

In women, pathology is often detected in the case of endometriosis, when the ureter is compressed by an enlarged uterus.

Symptoms of pathology in women and men

In most cases, the disease does not manifest itself for a long time and proceeds without any special symptoms. It is possible to identify the pathological process with the help of an X-ray examination. If obstruction of the ureter is diagnosed in men and women in an acute form, there are colic and painful sensations of a dull nature on the sides of the abdomen. In the case of complete obstruction, severe pain is noted, which is pronounced.

Often, with pathology, the patient experiences nausea and vomiting, in some cases, an elevated body temperature is added. The main symptom of the disease is a decrease in the amount of urine and its slow excretion. Over time, the work of the kidneys is disrupted due to the expansion of the pelvis and calyces. After urination, urine leaks from the urethra. The patient has an increase arterial pressure due to decreased kidney function. If an infectious lesion joins, the patient may have an increased urge to urinate. In advanced cases, sepsis and renal failure occur. If the above symptoms appear, you should immediately consult a doctor.

Diagnostics

If the obstruction is congenital, it can be diagnosed in the fetus even during intrauterine development using ultrasound diagnostics. Using this equipment, you can find out what malformations in the development of the kidneys, ureter and bladder are present in the fetus. If obstruction is suspected, prescribe general analysis urine and blood, which indicate an infectious disease, excess creatinine. These results are indicative of kidney failure.

Instrumental Methods

Accurate in determining the pathology are instrumental studies that are carried out in a medical setting. Ultrasound examination of the organs of the urinary system makes it possible to fully consider the structural changes in the internal organs. Voiding cystourethrography is also prescribed, which reveals a disturbed outflow of urine. The diagnostic procedure is performed using a small tube that is inserted into the urethra. Then a contrast agent is injected through it, which is highlighted during x-ray examination. During urination, places where the flow of urine is disturbed are fixed.

The patient is also recommended to undergo intravenous pyelography or excretory urography. This diagnostic method is similar to cystourethrography, with the only difference being that a contrast fluid is injected into a vein. Kidney scintigraphy is performed using a radiopaque substance, which contains a small amount of radioactive isotopes. The substance is injected intravenously and isotopes are visible on the camera indicating functionality internal organ. Cystoscopy is performed with a special small tube on which there is a camera. Through a small incision or urethra, a cystoscope is inserted into the patient and the organ is examined.

Effective diagnostic methods are computed tomography and magnetic resonance imaging.

At computed tomography the doctor takes several x-rays, choosing a different angle. After computer processing, you can consider the organs in cross section and study the problem in detail. Magnetic resonance imaging is performed using a magnetic field and radio waves, which create a detailed image of the ureter and kidneys, as well as the tissues of internal organs.

What are the treatments for ureteral obstruction?

First of all, therapy affects the restoration of normal excretion of urine, and then eliminates unpleasant symptoms. Treatment is carried out by different methods, depending on the degree of pathology and complications. In therapy, surgical and medical methods are used to eliminate obstruction of the ureter. Any of these should restore normal urine flow and eliminate kidney problems.

Restoration of the outflow of urine

If severe pain occurs, this indicates a violation in the functioning of the kidneys and a large accumulation of urine, which presses on the cups and pelvis of the organ. In this case, urgent intervention is needed to remove the urine and save the person. The urologist places a ureteral stent (hollow tube) into the ureter, which creates an additional lumen for urine to exit.

Accumulated urine can be removed using a percutaneous nephrostomy performed using an ultrasound device. The patient is injected with a catheter through which urine is removed from the renal pelvis. Bladder catheterization is possible. In this case, the catheter is inserted through the urethra into the bladder, and urine is collected in a special urinal. This method is used in cases where there are pathologies in the bladder.

A specialist should choose the appropriate option to restore urine flow. These procedures may be applied once or be permanent. Some patients require nephrostomy or ureteral stenting during chemotherapy. In this case, it is important to know that the kidneys are functioning normally and urine does not accumulate.

Drug therapy

In most cases, an infectious disease is added to the obstruction of the ureter, which needs special treatment. Since the problem of blockage of the ureter can only be eliminated by surgery, drug therapy is prescribed before or after surgery. As a rule, it consists in taking antibacterial drugs. In case of infection of the urinary tract, the course of antibiotic therapy can be extended, and the patient will be prescribed additional drugs.

Endoscopic surgery

The most painless method of therapy is endoscopic surgery. It is performed using an optical instrument (endoscope), which is inserted through the urethra into the ureter. During surgery, the surgeon makes an incision in the damaged organ and inserts a stent through which urine will be excreted. Endoscopic intervention is used in the diagnosis and treatment of pathology. After this procedure, a person needs a short recovery time.

Other types of operation

Depending on the degree of damage and the complications present, the patient is prescribed surgery of the most acceptable type. The patient may be prescribed ureterolysis, aimed at freeing the ureter from the resulting scar or fibrous tissue. In medicine, there are such types of surgical intervention for obstruction as:

• pyeloplasty;
• partial nephrectomy;
• ureterectomy;
• reimplantation of an internal organ;
• transureteroureterostomy.

Depending on the severity of the pathology, they can be performed by open, laparoscopic or robotic methods. The difference between surgical interventions lies in the duration of the patient's recovery after surgery. Only the attending physician can choose the necessary surgical intervention, based on the results of tests and studies.