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Diseases of the ureters

Congenital malformations of ureters. Such anomalies are found in 2-3% of pathoanatomical studies. They are of more scientific interest and have little clinical significance. Some anomalies can cause obstruction, and then the disease occurs.

The doubled and split ureters. Double ureters (formed from a double or split ureteric kidney) are almost always associated with a doubling of the renal pelvis or the abnormal development of a very large kidney. The latter has a partially split pelvis, ending in different ureters. Double ureters can go separately to the bladder, but they usually connect to the wall of the bladder and enter it through a single opening.

Obstruction of the ureterochondral articulation. This is a congenital disease, in the outcome of which hydronephrosis develops, usually occurs in boys. Most often the disease occurs on the left. However, the lesion may be bilateral; in 20% of cases occurs in girls. The disease is associated with improper organization of the smooth muscle bundles in the ureteric jugs or (very rarely) with the compression of this area by additional renal vessels. For unknown reasons, in a significant number of cases, kidney genesis from the opposite side is observed.

Diverticula These sacculate protrusions of the ureter wall are quite rare. They are both congenital and acquired as a result of stagnation and infections. Expansion, lengthening and tortuosity of the ureters (hydroureter) are regarded as congenital anomalies or acquired defects. It is believed that a congenital hydrofluorometer reflects defects in the innervation of the muscles of the ureter. A massive increase in the ureter, known as a megaloureter, seems to be due to defects in the muscles of the ureter. Sometimes these abnormalities are accompanied by a congenital defect of the kidney.

Ureteritis The disease develops due to urinary tract infections. Morphological changes in this case are not specific. The persistence (persistence) of infection or repeated acute periods can cause chronic inflammatory changes in the ureters. In some cases of prolonged chronic ureteritis, a specific reaction is observed. Accumulation or aggregation of lymphocytes in the subepithelial region can cause weak swelling of the mucous membrane and the appearance of fine grain on its surface (follicular ureteritis). However, the mucous membrane may contain small cysts with a diameter of 1-5 mm (cystic ureteritis). The same changes appear in the bladder. Cysts can form small grape-like clusters. Histologically, such cysts are lined with altered epithelium with a flattened surface layer.

Tumors and tumor-like diseases of the ureters.
Primary tumors of the ureters are very rare, metastasis of tumors of other localization is much more common. Small benign tumors of the ureter usually have a mesenchymal origin. These include tumors from the connective tissue, blood vessels, lymphoid tissue and smooth muscles. As a rule, such tumors are well encapsulated and are found in the form of submucosal nodules with a diameter of less than 1 cm, which seldom reach sizes sufficient for obstruction of the ureter.

Fibroepithelial polyp. This is a rare tumor-like formation, which is macroscopically represented by small masses protruding into the lumen, and is found more often on the left than on the right. In addition to the ureter, a polyp is found in the bladder, renal pelvis and urethra. It is a vascular connective tissue formation, located under the mucous membrane.

Malignant (epithelial) tumors of the ureter. They are similar to those tumors that develop in the lining of the renal pelvis and calyx, as well as in the bladder. After all, all these structures are covered with transitional epithelium (urotelium). These tumors can close the lumen of the ureter. Most often they occur during the 6th and 7th decades of life, are multiple, combined with similar tumors in the bladder and renal pelvis.

Obstructive diseases of the ureter. A variety of injuries can cause ureteral obstruction with the development of hydroureter, hydronephrosis, and sometimes pyelonephritis. The greatest clinical significance in these cases is not the expansion of the ureter, but the involvement of the kidney in the process.

Sclerosing retroperitoneal fibrosis. This is a rare disease of unknown etiology. It is accompanied by a narrowing or obstruction of the ureter and causes the development of hydronephrosis. There is information about the side effects of some drugs. However, in most cases, the causes of the disease remain unknown. In some cases, similar fibrous changes were found in other places (mediastinal fibrosis, sclerosing cholangitis, fibrosing thyroiditis - Riedel's disease), which allows us to think about the systemic nature of the disease. Thus, when taking certain drugs, an autoimmune reaction seems to develop.

The disease is characterized by the appearance of fibrous masses, which begin to progressively increase above the sacral protrusion, surround the lower part of the abdominal aorta and extend laterally into the retroperitoneal space, surrounding the ureters. Microscopically detect inflammatory fibrosis with massive infiltration of lymphocytes, often with the formation of germinal centers, plasma cells and eosinophils. Sometimes there are foci of necrosis and granulomatous inflammation near the zone of fibrosis.

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Diseases of the ureters

    The ureter (ureter) is a paired organ that performs the function of removing urine from the kidney into the bladder. It has the shape of a tube with a diameter of 6-8 mm, a length of 30-35 cm. It distinguishes the abdominal, pelvic and intrasteal parts. The abdominal part lies retroperitoneally, goes along the middle surface of the psoas major muscle to the small pelvis. The right ureter originates from the level of the descending part of the duodenum,
  2. Obstruction of the ureters.
    Obstruction of the ureters - an obstacle to the flow of urine into the ureter. It leads to the development of hydronephrosis, hydrouronephrosis and impaired renal function. Unilateral obstruction of the ureter often remains clinically unnoticed, leading to atrophy of the renal parenchyma, disruption of its functioning. The second kidney is compensatory hypertrophied and compensates for the lost function. Sharp double sided
    In some patients suffering from malignant diseases, during extensive operations in the pelvis resection of the terminal part of the ureter is performed. In such cases, the passage of urine can be saved by transferring the ureter to the bladder or transperitoneal ureteral transfer to the ureter. If the opposite ureter is healthy and normal, and the distance between the excised
    In some cases, the damaged area of ​​the ureter can be located quite high in the pelvis. This provides the possibility of imposing anastomosis, without resorting to the transfer of the ureter into the bladder. In these cases, the ureter may be damaged near the plane of the entrance to the small pelvis during the seizure, dissection and ligation of the funnel ligament or the removal of extensive ovarian carcinoma,
  5. Tumors of the pelvis and ureter.
    Tumors of the pelvis and ureter are rare and in 90% of these are transitional crayfish. Mesenchymal tumors of the pelvis and ureters are extremely rare. Of benign tumors of the pelvis, there is more often transitional cell papilloma (can be solitary or multiple), which is characterized by exophytic growth, often ulcerate, causing hematuria, but does not germinate the wall of the pelvis.
  6. Pathology of the ureters
  7. Bladder and ureters
    Bladder and
    In some cases, a significant portion of the ureter has to be removed due to its radiation injury and / or chronic inflammation. After such an operation, you should not try to connect with the bladder a narrowed, irradiated and inflamed area of ​​the ureter. In such cases, provided that there is a relatively healthy kidney, it is possible to perform three different reconstructive operations: 1)
    Reimplantation of the ureter into the bladder is necessary in cases of congenital abnormalities, if the ureter is damaged during surgery, or during irradiation. If there is a complete obstruction of the ureter, then you should resort to the imposition of percutaneous nephrostomy puncture, and surgical plastics to postpone until the optimum conditions for the operation. Every hour complete kidney obstruction
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