Ureterocele
| Classification according to ICD-10 | |
|---|---|
| N28.8 | Other specified diseases of the kidney and ureter - ureterocele |
| ICD-10 online (WHO version 2019) | |
A ureterocele , English ureterocele , is a spherical enlargement of part of the ureter in the urinary bladder during or after passing through the bladder wall. A distinction is made between orthotopic (intravesical) and ectopic (caudal dystopic) ureteroceles depending on the relation to the ostium . A ureterocele is often associated with ureteral stenosis or vesicorenal reflux , but it can also remain symptom-free.
Basically, the part of the ureter that runs in the urinary bladder wall is affected. Ureteroceles can become very large and under certain circumstances fill the entire bladder and thus possibly escape ultrasound detection. If such large ureteroceles compress the opposite ureter, this can lead to bilateral urine build-up, possibly with subsequent kidney failure.
In most cases of ureterocele, there is a double kidney system, with the outflow from the upper (cranial) hollow system flowing caudally dystop and from the lower (caudal) system orthotopically (Weigert-Meyer rule). Approximately 10% of orthotopic ureteroceles have a normal system of the hollow system, including adult ureterocele due to regular lack of symptoms or symptoms that appear late . called.
The ureterocele often only has a very small opening in the urinary bladder and, depending on how full it is, bulges into the bladder. This stenosis causes a urinary outflow disorder in the associated hollow system, the ureter can be meandering in its entire course up to the kidney and expanded like a sac. Increases in pressure in the renal hollow system damage the kidney function, drainage disorders in the urinary organs are often the cause of a secondary or chronic infection.
diagnosis
Possibly. the urine findings show signs of chronic infection, but this is unspecific. In the past, the diagnosis was made in the excretory urogram or micturition cystoureterogram through the detection of a characteristic recess in the bladder shadow and an expansion of the associated hollow system ("snake head sign"). Today the diagnosis is based on ultrasound of the lower urinary tract with the guiding criteria
- Marginal cyst on the bladder bloom
- dilated afferent ureter
- Double system of the hollow system of a kidney
therapy
Various treatment methods are available:
- endoscopic slitting of the ureterocele, procedure of choice.
- Re-implantation of the ureter in the bladder wall with an antireflux plastic.
- Establishing a connection between the two parts of the doubled renal pelvis with partial removal of the then functionless second ureter.
- In the event of a substantial loss of function of the associated part of the kidney, this can be removed with partial removal of the associated ureter.
Individual evidence
- ^ Pschyrembel: Clinical Dictionary. de Gruyter, Berlin.
- ↑ C. Weigert: About some defects in the formation of the ureters. In: Virchow's archive of pathological anatomy. 70 (1877), pp. 490-501.
literature
- R. Hautmann, H. Huland: Urology. 3. Edition. Springer Verlag, 2006, ISBN 3-540-29923-8 , p. 397 f.
- W. Schuster, D. Färber (Ed.): Children's radiology. Imaging diagnostics. Springer, 1996, ISBN 3-540-60224-0 .
- M. Bettex, N. Genton, M. Stockmann (Eds.): Pediatric Surgery. Diagnostics, indication, therapy, prognosis. 2nd Edition. Thieme, 1982, ISBN 3-13-338102-4 .
- V. Hofmann, KH Deeg, PF Hoyer: Ultrasound diagnostics in pediatrics and pediatric surgery. Textbook and atlas. Thieme, 2005, ISBN 3-13-100953-5 .
- FC Sitzmann: Pediatrics. Diagnostics - therapy - prophylaxis. 6th edition. Hippocrates, 1988, ISBN 3-7773-0827-7 .
