Treatment of ureterocele

Congenital and acquired causes of ureterocele are distinguished. Congenital pathology includes anomalies of the distal ureter in the form of elongation of the intramural segment and narrowing in the area of the ureteral orifice.

The development of acquired ureterocele is promoted by calculi (stones) — formations that pass through the ureter together with urine and may obstruct it. The most common obstruction occurs when a stone blocks the ureteral orifice, which is the narrowest part.

Under the pressure of urine, the walls of the ureter gradually stretch, resulting in the formation of a ureterocele. After emptying, the protrusion decreases in size through the orifice until the next filling with urine.

The severity of symptoms directly depends on the stage of the disease and the degree of impairment of urine outflow:

• at the first stage, a slight dilation of the intravesical part of the ureter is observed without impairment of kidney function;

• at the second stage, the ureter becomes dilated, an excessive amount of urine accumulates in it, and ureterohydronephrosis develops;

• at the third stage, pronounced dysfunction of the kidneys and the urinary bladder is formed.

Certain clinical features of the disease are determined by anatomical differences in the genitourinary system of patients of different sexes.

Ureterocele in women, due to anatomical features of the urethra, is more often accompanied by dysuric disorders, a feeling of pressure or discomfort in the pelvic area, and in some cases — prolapse of the formation into the urethra.

Ureterocele in men is usually associated with impaired urine outflow and symptoms of infravesical obstruction. Patients may complain of a weakened urine stream, urinary retention, and an increased risk of inflammatory diseases of the genitourinary system.

Small ureteroceles may be detected incidentally during ultrasound examination of the urinary bladder. The condition is often diagnosed during the evaluation of patients with recurrent infectious lesions of the genitourinary tract.

Diagnosis of ureterocele may include:

• physical examination;

• palpation;

• urine and blood tests;

• ultrasound examination of the kidneys and urinary bladder;

• excretory urography;

• nephroscintigraphy;

• uroflowmetry;

• cystoscopy.

During the consultation, the urologist analyzes the patient’s complaints, уточнiates the nature of symptoms, and collects the medical history. During the physical examination, palpation is performed: a kidney enlarged due to pronounced hydronephrosis may be palpable. Palpation of the suprapubic area in patients with ureterocele is often painful.

Blood tests reveal signs of an inflammatory process, including elevated leukocyte levels and erythrocyte sedimentation rate. Urinalysis may show erythrocytes, leukocytes, protein, pus impurities, and bacteria. Ultrasound examination of the kidneys clearly visualizes signs of hydronephrosis. Ultrasound of the urinary bladder in the presence of ureterocele identifies a round, thin-walled protrusion filled with fluid.

Excretory urography is an X-ray examination of the pelvic area with prior intravenous administration of a contrast agent. It allows assessment of the condition of the urinary tract, localization of the pathological process, and the degree of dilation of the renal collecting system and the ureter. Nephroscintigraphy makes it possible to evaluate the rate of urine outflow.

The most complex yet highly informative diagnostic method is cystoscopy. During this procedure, a cystoscope—a flexible thin tube with a camera and a light source—is inserted through the urethra into the urinary bladder. Using the optical system of the device, the physician can directly assess the condition of the mucous membrane, the location of the formation, and its size.

Ureterocele leads to the development of hydronephrosis — a condition in which, due to impaired urine outflow, the renal calyces and pelvis become dilated and a significant amount of urine accumulates in them.

Hydronephrosis contributes to the development of pyelonephritis — inflammation of the kidney caused by urine stasis, which creates a favorable environment for pathogenic microorganisms. The formation of kidney stone disease is also possible, when urinary salts precipitate and form calculi.

In addition, a complication of ureterocele may be renal arterial hypertension — an increase in blood pressure that is not responsive to drug therapy. Another possible consequence is kidney atrophy, in which nephrons are replaced by connective tissue that is incapable of filtering blood and producing urine.

The final stage of the pathological process may be chronic kidney failure, which poses a serious threat to human health and life.

Secondary ureterocele can be prevented by following a balanced diet that reduces the risk of stone formation in the urinary tract. It is also important to diagnose and treat infectious diseases in a timely manner, not to ignore their symptoms, and to consult a urologist when complaints occur.

Congenital ureterocele cannot be prevented due to the lack of a complete understanding of the mechanisms of formation of this pathology. To reduce the risk of ureterocele development in a child, the expectant mother is advised to plan pregnancy and minimize the impact of adverse factors on the body.