Ureteral cyst

Introduction Ureteral cyst: is a cystic dilatation of the end of the ureter. During the embryonic development, the septum between the ureter and the urogenital sinus does not absorb and resolve, forming different degrees of stenosis of the ureteral orifice, or the fibrous structure at the end of the ureter is weak or the path between the wall is too long, and the curve is caused by the urinary flow. After the formation of a cystic dilation into the bladder. Early cases are clinically asymptomatic and are often found in the diagnosis of severe renal deformities. Symptoms are mainly urinary tract obstruction, causing repeated urinary tract infections. Due to the small opening of the cyst, persistent obstruction of the ureteral orifice can lead to ureter and hydronephrosis, loss of renal function, cystic occlusion of the bladder neck, dysuria or interruption of urinary flow, and recurrent urinary tract infection. Sometimes girls cysts can be removed from the urethra through the bladder neck and urethra, and can usually be reset by themselves. However, an incarcerated purple mass can also occur. The principle of treatment is to relieve obstruction, prevent reflux, and deal with complications. If the upper half of the affected side is dysfunctional, it can be used for partial nephrectomy. About 20 to 25% of cases still have symptoms after surgery, and the cysts are treated again. If the kidney function is good, it can be used for ureteral cyst resection and anti-reflux ureteral bladder replantation.

Cause

Upper urinary tract obstruction due to poor urine flow. The Chwalle membrane temporarily separates the ureteral bud and the urogenital sinus 37 days after fertilization of the egg, causing the disease when the Chwalle membrane is incompletely dissolved. In addition, abnormalities in the ureteral muscle development of the bladder wall segment can also be caused. The most common clinical manifestations are upper urinary tract hydronephrosis and urinary tract infection.

an examination

Related inspection

Intravenous urography with ureteral ultrasonography

Imaging studies can confirm the diagnosis. B-mode ultrasonography can show a thin-walled cystic mass in the bladder. Typical venous urography is characterized by a "snake" swell at the end of the ureter, with or without renal ureteral dilatation, and may also be indicated when combined with repeated deformities. Cystoscopy showed a cystic dilatation at the ureteral opening, and the opening was pinpoint-like as the ureter squirmed.

The ureterocele is due to congenital stenosis or functional contracture of the ureteral orifice and dysplasia of the ureteral wall, so that a cyst of the lower end of the ureter forms a cyst into the bladder. Therefore, the outer layer of the cyst is the bladder mucosa, and the inner layer is the ureter mucosa. The thin layer of the ureter is between the two.

According to the relationship between the position of the ureteral orifice and the cyst, it is divided into simple type and ectopic type.

The former ureteral orifice is slightly offset from the normal position (orthotpic ureterocele), the cyst is often small, less affected, more common in adults, also known as adult. Ectopic ureteral cysts are large and complicated by heavy renal ureteral malformations. Two ureters penetrate the bladder muscle layer at the usual site, the lower ureteral ureter opens in the bladder triangle, and there is a ureteral cyst, which drains the upper ureter. It is located in the submucosal layer and opens in the bladder neck or posterior urethra. Clinically, there are also those between the two types.

Differential diagnosis

The diagnosis should be differentiated from the following symptoms:

1. Ureteral pain: ureteral pain is often an acute attack, and more often secondary to acute ureteral obstruction.

2. Ureteral stenosis: There are 3 physiological curvatures of the ureter, which is the stenosis. The first stenosis is penetrated into the bladder wall; the second stenosis is inserted across the radial artery into the small pelvis; the third stenosis is penetrated into the bladder wall.

Ureteral stenosis refers to the ureteral lumen or part of the ureteral lumen is narrower than normal due to various reasons. Although the continuity of the lumen is not interrupted, it has caused different degrees of upper urinary tract obstruction and hydronephrosis.

3. Ureteral obstruction: obstruction of the ureteropelvic junction is a common urinary tract obstruction that causes hydronephrosis. Because the obstruction of the ureteropelvic junction obstructs the smooth discharge of renal pelvis into the ureter, the renal pelvis emptying disorder causes the renal system to expand. At first, the smooth muscle of the renal pelvis gradually proliferates, strengthens the peristalsis, and attempts to discharge the urine through the distal obstruction; when the increasing amount of creeping power cannot overcome the obstruction, it will lead to atrophy of the renal parenchyma and impaired renal function.

4. Ureteral fistula: The ureter is a slender, muscular organ composed of tubular organs located in the retroperitoneal space, with good surrounding protection and considerable range of motion. Muscles suddenly do not arbitrarily contracture, commonly known as cramps, will make patients feel severe pain, muscle movements are not coordinated. The patient straightens the muscles of the affected area and usually reduces the degree of paralysis.

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