Megaureter

Introduction Congenital giant ureter is due to abnormal development of the ureteral muscle structure (increased ring muscle, lack of longitudinal muscle), resulting in functional obstruction of the ureter, severe expansion of the ureter or even renal pelvis, and accumulation of water. The disease is characterized by functional obstruction at the end of the ureter without significant mechanical obstruction. The ureteral dilatation above the obstructive segment is most evident in the pelvic segment, also known as congenital ureteral functional obstruction.

Cause

There is no consensus on the etiology at present. It may be the proliferation of the ureter muscle layer or the imbalance between the muscle bundle and the fibrils in the embryonic development. The lower end of the ureter is narrow near the bladder, and the stenosis is in sharp contrast with the dilated segment. In some cases, transverse mucosal folds or canvas-like valves can be seen in the lower end of the ureter.

The distal unpowered giant ureter has no anatomical stenosis, but the proximal end is dilated, and there is no peristaltic function. The microscopic ureteral muscle layer is relatively lacking, the ring muscle hyperplasia, and some the number of intermuscular nerve cells are reduced.

an examination

Related inspection

Urine routine intravenous urography

There is no specific clinical manifestation of this disease. Most of them are treated with backache and pain, and occasionally due to lumbar mass and renal insufficiency. Due to the lack of specific clinical manifestations and signs, the diagnosis depends on imaging examination.

Differential diagnosis

1. Severe vesicoureteral reflux can cause reflux giant ureter, clinically manifested as backache and low back pain, but there is aggravation of low back pain when urinating. The IVU examination showed that the affected kidney and ureter were dilated and the ureter was more obvious. During the urinary bladder angiography, the contrast agent can be found to flow into the ureter.

2. Lower ureteral stones can cause kidney and ureteral hydrops, secondary infections may have fever, frequent urination, urgency and dysuria. The patient may have renal colic. The shadow of the ureteral path is visible on the KUB flat. Urography showed excretion obstruction at the stone site, ureter and hydronephrosis above the obstruction. Negative stones can be found by B-ultrasound and CT examination.

3. can cause ureteral stenosis and cause kidney and ureteral water. However, most patients have progressive urinary frequency, urgency, dysuria and hematuria, and there is rice soup pyuria. Urography showed renal pelvis and renal pelvis destruction, and the renal parenchyma formed a cavity. The ureter was worm-like or bead-like, and the lumen was narrow. Examination of visible lesions around the ureteral orifice congestion, edema and ulcers, and tuberculous nodules.

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