Angina

Obstruction of the urinary tract. Infravesical obstruction is a pathology that interferes with the outflow of urine.

Urinary tract obstruction is a condition of the body when there is some kind of obstruction to the outflow of urine at different levels. This pathology requires prompt intervention, since the complications and consequences can be very dire. Women and older men are more likely to get sick.

Types of obstruction and causes of its occurrence

Below we will discuss the main levels of obstruction and the etiological factors that provoke it.

Obstruction at the level of the ureter

This type of lesion occurs quite often and has a number of dangerous features for the body.

Through a healthy ureter, urine passes freely into the bladder and the patient maintains diuresis. This somewhat masks the disease, and they consult a doctor a little later.
Increased pressure in the collecting system, if not detected in time, can lead to the development of hydronephrosis and irreversible renal failure.

Congenital disorders

Stenosis of various segments of the ureter.
Retrocaval ureter (located behind the vena cava and compressed by it).
Ureterocele.

Acquired disorders

A tumor of both the ureter itself (rarely) and adjacent organs (more often).
Movement of a stone from the renal pelvis to the ureter.
An inflammatory disease accompanied by swelling and thickening of the walls.
Fibrosis of the ureter.
Deposition of urate crystals.
Blockage by a blood clot.
Compression by the pregnant uterus.
Compression of the uterus by a tumor.
Inflammatory diseases of the uterus and its appendages.
Accidental ligation of the ureter during pelvic surgery.

Obstruction at the bladder neck level

In this case, the outflow of urine from the bladder is disrupted and increased pressure affects both kidneys at once.

Congenital malformations

Bladder neck obstruction.
Ureterocele.

Acquired deviations

Tumors of the bladder and adjacent organs (benign and malignant).
Stones in the bladder.

Obstruction at the level of the urethra

Congenital pathology

Valves at the back or front of the urethra.
Urethral strictures.
Stenosis.

Acquired disorders

Strictures formed as a result of inflammatory diseases of the urethra.
Stones entering the urethra from the kidneys and bladder.
Consequences of injuries.
Tumors of the urethra.
Acquired phimosis.

Clinical manifestations of urinary tract obstruction

Side pain This is the most common sign of obstruction. It occurs as a result of stretching of the elements of the collecting system due to increased pressure on their urine wall. Pain can be expressed to varying degrees depending on how quickly the pressure increases (the rate of urine secretion) and how much the patency of the tract is reduced. If the obstruction is acute (stone), then the pain is very pronounced, excruciating, radiating to the lower abdomen and external genitalia.

If stenosis develops gradually, then the body begins to adapt. A healthy kidney (in case of damage to one organ) takes on an additional burden. The kidney tissue on the affected side may become thinner, increasing the volume of the pelvis and calyces. Ultimately, there are practically no nephrons left in the kidney and it cannot cope with its function.

Difficulty urinating and starting to urinate.
Leakage of urine from the urethra after urination.
Frequent urination.
Lack of urine is a very serious symptom.
Increased blood pressure is a consequence of decreased kidney function. It develops in the absence of treatment or when it is ineffective.

Diagnosis of urinary tract obstruction in Israel

First of all, doctors collect a detailed medical history and evaluate all the patient’s complaints. Afterwards a general examination is carried out and tests are prescribed.

General and biochemical blood tests. Based on their results, one can judge how well the kidneys cope with their function. In the case of renal failure, the content of nitrogen compounds in the blood gradually increases.
Urine tests– allow one to judge the concentrating ability of the kidneys and provide information about the chemical composition of urine.
Digital rectal examination(for men) - allows you to identify a hypertrophied prostate gland, compressing the urethra.
Gynecological examination allows you to exclude tumors of the female genital organs.
Plain X-ray of the abdominal cavity– allows you to detect X-ray positive stones and nephrocalcinosis.
Bladder catheterization- a therapeutic and diagnostic measure that allows you to obtain urine and ensure its outflow in a number of cases.
Ultrasound examination.
Excretory urography– injecting a contrast agent into the patient’s bloodstream and taking a series of photographs showing how the kidneys remove it from the body.
- a very accurate method, similar in principle to the previous one, but only the removal of labeled atoms is monitored.
Retrograde and anterograde pyelography.
Cystoureteroscopy– examination from the inside of the bladder using a special device inserted into the body through the urethra.
Vaccine cystourethrography– pictures of the bladder during its contractions. Allows you to detect the reflux of urine from the bladder into the ureter.
CT and MRI allow to exclude or confirm compression of the organs of the urinary system from the outside by tumors.

Treatment of urinary tract obstruction in Israel

Israeli doctors realize how dangerous tract obstruction is and immediately take all necessary measures to eliminate it. Otherwise, the patient is likely to develop kidney failure, which will force the person to undergo regular dialysis and greatly reduce the quality of life.

If the obstruction is acute, then the patient undergoes nephrostomy, ureterostomy, catheterization - all measures that ensure the outflow of urine from the body.
Ureteral catheterization can be performed over a relatively long period of time. This ensures the outflow of fluid from the kidney and protects its cortex and medulla from atrophy.
Treatment with antibiotics is indicated in cases where obstruction is combined with an infectious disease of the genitourinary tract.

Treatment methods can differ radically, since it all depends on what caused the difficulty in passing urine from the body.

Stones can be removed surgically or crushed using lithotripsy.
Urethral strictures are treated with surgery. In men, treatment very often comes down to removing hypertrophied prostate tissue. Israeli clinics actively use minimally invasive techniques that make it possible to treat a patient without making skin incisions.
If the obstruction is caused by a tumor compressing the organs of the urinary system, then it can be eliminated by removing the tumor.
In rare cases, obstruction is caused by functional disorders of the urinary organs. In this case, the patient can be cured with the help of drugs without resorting to surgery.

To be treated in our clinics means to entrust your health to the most reliable hands!

Hydronephrosis is Greek for "water in the kidneys." Hydronephrosis is a common congenital disease or condition that occurs in about 1 in 500 babies. However, hydronephrosis can also appear later in life in both children and adults. Hydronephrosis is a disease in which the outflow of urine into the bladder occurs more slowly than it should, and as a result, this leads to the fact that urine accumulates in the renal pelvis in greater quantities than it should and thereby disrupts the normal functioning of the kidney. Hydronephrosis can affect one kidney (unilateral) or both kidneys (bilateral).Hydronephrosis can be "prenatal" or "antenatal", as well as postnatal. The term "prenatal" or "antenatal" means that hydronephrosis was detected in the child before birth. .

Obstruction or blockage is the most common cause of hydronephrosis. This may be due to problems that occur during pregnancy, in the fetus (prenatal), or may be a physiological response to pregnancy. About 80% of pregnant women develop hydronephrosis or hydroureter. According to experts, this occurs, in particular, due to the effect of progesterone on the ureters, which in turn reduces their tone.

Nowadays, hydronephrosis is usually initially diagnosed with prenatal ultrasound. Detection of hydronephrosis while the baby is in the womb has become more common due to advances in prenatal ultrasound testing. Before the development of this technology, children born with hydronephrosis could not be accurately diagnosed until they began to show symptoms of kidney disease, and often the hydronephrosis might not be detected at all. Many children diagnosed with prenatal hydronephrosis are able to recover on their own at a very early age, without medical intervention.

Facts about hydronephrosis

Hydronephrosis is swelling of the kidneys with partial or complete disruption of the outflow of urine from the kidney to the bladder.
Hydroureter is swelling of the ureter, the canal that connects the kidney to the bladder.
Obstruction (obstruction or blockage) can occur at any level.
Depending on the level of cause, hydronephrosis can be unilateral (affecting one kidney) or bilateral (affecting both kidneys).
High blood pressure caused by hydronephrosis can potentially compromise kidney function if it is not reduced promptly.
Symptoms of hydronephrosis depend on whether the swelling occurs acutely or progresses gradually. If it is an acute obstruction, symptoms may include severe pain, nausea and vomiting.
Treatment of hydronephrosis and hydroureter is aimed at restoring the outflow of urine from the affected kidney.

Kidney anatomy

Kidneys- paired bean-shaped organs located along the posterior wall of the abdominal cavity. The left kidney is located slightly higher than the right kidney because the right side of the liver is much larger than the left. The kidneys, unlike other organs of the abdominal cavity, are located posterior to it and are in contact with the muscles of the back. The kidneys are surrounded by a layer of fatty tissue that holds them in place and protects them from physical damage. The kidneys also filter metabolic waste, excess ions and chemicals in the blood, thereby producing urine.

Ureters are a pair of tubes or canals that carry urine from the kidneys to the bladder. The length of the ureters is approximately 10-12 cm and runs along the left and right sides of the body parallel to the spinal column. Gravity and the peristalsis of smooth muscle tissue in the walls of the ureters move urine towards the bladder. The ends of the ureters closer to the bladder are slightly expanded and compacted at the point of entry into the bladder itself, forming so-called valves. These valves prevent urine from flowing back to the kidneys.

Bladder is a hollow, sac-shaped organ used by the body to collect and retain urine. The bladder is located along the midline of the body in the lower part of the pelvis. Urine coming from the ureters slowly fills the cavity of the bladder, stretching its elastic walls, which allows it to hold from 600 to 800 milliliters of urine.

Urine produced by the kidneys is transported through the ureters to the bladder. The bladder fills with urine and stores it until the body is ready to eliminate it. When the volume of the bladder reaches approximately 150 to 400 milliliters, its walls begin to stretch, affecting their receptors, which in turn send signals to the brain and spinal cord. These signals lead to involuntary relaxation of the internal urethral sphincter, and the person feels the need to urinate. Urination can be delayed until the bladder has exceeded its maximum capacity, but the increased nerve signals can lead to great discomfort and the urge to urinate.

Hydronephrosis in children

Causes of hydronephrosis in children

A number of conditions can lead to hydronephrosis. Specialists in the field of pediatric urology work individually with each patient, identifying the cause of hydronephrosis in each child, in order to then create an individual treatment plan. In some children, the underlying cause of hydronephrosis cannot be determined.

While there are many conditions that lead to hydronephrosis, the most common causes are obstructions (blockages) that reduce the ability of urine to pass from the kidney to the bladder. These obstructions may include:

Ureteropelvic obstruction is a blockage or blockage at the point where the kidney meets the ureter (the tube that carries urine to the bladder).
Ureterovesical segment obstruction is a blockage or blockage at the point where the ureter meets and connects to the bladder.
Posterior urethral valve is a congenital condition found only in boys. They are pathological valves made of tissue in the urethra (the canal that carries urine out of the body), preventing the free passage of urine from the bladder.
Ureterocele - occurs when the ureter does not develop properly and a small pouch forms in the bladder.

Other reasons may be:

Vesicoureteropelvic reflux - occurs when urine from the bladder flows back into the ureters and often back into the kidneys. When the sphincter muscles at the junction of the ureter and bladder do not work properly, urine backflows and moves back up to the kidney.
Ectopic ureter is a congenital anomaly in which the ureter secretes urine outside of the bladder.

urinary tract infections.

Acute hydronephrosis

Chronic hydronephrosis

no symptoms at all.

When to see a doctor

Diagnosis of Hydronephrosis in children

Ultrasound examination
Most parents are familiar with ultrasound from the moment of pregnancy. Ultrasound is a non-invasive test that produces sound waves that transmit images to a screen . An ultrasound is passed through the kidneys to determine the size, shape, and weight of the kidney and detect the presence of kidney stones, cysts, or other obstructions or abnormalities.

Mixture cystourethrography
This is a specific x-ray that examines the urinary tract and allows specialists to see a direct image of the bladder and vesicoureteral reflux, if present. A catheter (hollow tube) is placed into the urethra and the bladder is filled with liquid dye. X-rays are taken as the bladder fills and empties. The images show whether there is backflow of urine into the ureters and/or kidneys. They also show the size and shape of the bladder and urethra.

Cystourethrography is a common procedure, but some children and their parents find insertion of the catheter to be unpleasant. In such cases, it is recommended to use a numbing gel to relieve discomfort. By talking gently to the child before the procedure about possible discomfort, adults can help ease the child's anxiety. The calmer the child is during the procedure, the less discomfort he will feel.

Measuring urine flow rate
This method is often performed in children who have urinary incontinence, the need to urinate frequently, urinary tract infections, hypospadias, vesicoureteral reflux , vesicoureteral reflux, meatal stenosis.

The child will be asked to drink water before the procedure to keep the bladder comfortably full of urine. The child will urinate in a special toilet that has a small bowl at the base to collect the urine. This bowl is connected to a computer and has a measuring scale on it (similar to a kitchen measuring cup). The computer is able to analyze information about the flow of urine. This test is non-invasive and the patient will urinate as usual.

Measuring residual urine volume
A residual urine volume measurement may be performed to determine whether the patient is able to empty the bladder. This is usually done immediately after residual urine volume measurements. After the patient urinates, a small scan of the bladder is performed using ultrasound. This allows you to see how much urine is left in the bladder after urination. This method is not invasive.

X-ray of the kidneys, ureters and bladder
X-rays may be performed to identify the cause of abdominal pain, to evaluate the organs and structure of the genitourinary system and/or the gastrointestinal (GI) tract. X-rays of the kidneys, ureters, and bladder may be a diagnostic procedure used to evaluate the urinary system or bowel.
X-rays use invisible electromagnetic rays used to produce images of internal tissues, bones and organs on special film or a computer monitor. X-rays are produced using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through body tissue onto specially treated plates (similar to a film camera) and a “negative” picture is taken (the harder and denser the structure, the more pronounced it appears on film).

Magnetic resonance imaging ( MRI)
MRI is one of the most informative diagnostic procedures. MRI allows you to create three-dimensional and two-dimensional images of organs, which in the case of hydronephrosis, allows you to accurately determine the cause of the disease, the stage of the disease, as well as changes in the kidney tissue. Some of the positive aspects of using MRI are that it does not use ionizing radiation, the contrast agents that can be used during the study do not cause allergies, there is no need to change the position of the patient’s body to obtain an image of a particular organ or from a different angle. In addition to the positive aspects, there are also negative ones - for examination, the patient is inserted into a large closed hollow tube - this can cause an attack of claustrophobia (fear of closed spaces), if you have metal objects in the body (dental crowns, plates for osteosynthesis, screws in bones), you will not be allowed to perform this test (because the MRI uses a very powerful magnet, it can remove metal objects from the body, so always tell your doctor if there are metal objects in your body). The procedure takes from 20 to 80-90 minutes.

Videourodynamic and Urodynamic study.
A urodynamic study is done to measure the pressure inside the bladder when it is empty, when it is full, and when it is emptying. This test method uses two thin catheters. One catheter is inserted into the patient's bladder through the urethra, and the other catheter is inserted into the rectum. The bladder then fills with water. The pressure inside the bladder, rectum and abdominal cavity is constantly monitored. This test measures pressure, muscle contraction, and bladder potential. Video-urodynamic testing is performed during a urodynamic procedure to clearly visualize the urethra, bladder, and ureters.

Renal scan
This is a nuclear medicine test performed to provide images of the kidneys that will help determine the presence and areas of damage to the kidney. Neither before nor after this study, patients were subject to any dietary or activity restrictions. This procedure can take several hours, so parents are advised to bring toys and books for the child from home.

Radioisotope kidney scan
Radioisotope Kidney Scan is a research method from the field of nuclear medicine that allows, through imaging of the kidneys, to obtain more detailed information about the function of the kidneys, their size, shape, position and blockage of the urinary stream. The patient is injected intravenously with a radiolabeled drug (usually Technetium or Iodine radioisotopes) and its accumulation in the kidneys and the rate of excretion are visualized. At the moment, MAG 3 (Mercaptoacetyltriglycerol) is considered the best drug. In this study, there are no restrictions on food intake and vigorous activity.

Bacteriological examination of urine
Bacteriological analysis of a sterile urine sample taken from the child is performed in the office. If the child is toilet trained and urinates in the toilet on a regular basis, a urine sample will be collected in a small, sterile cup. If the child is not yet using the toilet independently, a catheter or small bag is placed on the genitals to collect urine. This urine is then examined in the office to look for abnormal contaminants that normally should not be in the urine, such as blood or protein.

Microscopic urine analysis
Using the same urine collection technology as in the bacteriological method, the sample is sent to the laboratory for more in-depth analysis. A microscope is used to detect certain abnormalities in the urine. This test is performed when a urinary tract infection is suspected.

Urine culture
If a urine sample shows the presence of bacteria, a urine culture is usually performed. Cultures of the bacteria are grown in the laboratory for 24 hours to determine what type of bacteria it is and what drugs are most effective in treating it.

24-hour urine analysis
A 24-hour urine test is often performed in children with kidney and bladder stones. Urine is collected in a special container for a full 24-hour period. When collecting urine for this study, the child's first void of the day is not included. Urine is then collected for the remainder of the day and night, and the first urination is made the next morning. The entire volume of urine obtained is sent to the laboratory, where a urine test is performed to identify the causes of stone formation in the human body.

Creatinine level
Creatinine levels are tested in children with severe symptoms of kidney disease. Creatinine is filtered from the blood through the kidneys. If the kidneys do not filter well, the level of creatinine in the blood will rise.

Treatment of Hydronephrosis in Children

What is the treatment for hydronephrosis?
Most children will need to undergo ultrasound examinations approximately every three months during the first year of life so that specialists can correctly determine the extent and progression of hydronephrosis. Many children diagnosed with prenatal hydronephrosis are closely monitored by doctors because their condition can normalize on its own over time without surgical intervention. In most cases of mild and moderate forms of hydronephrosis, only periodic monitoring is necessary.

If a child's hydronephrosis worsens over time or is initially diagnosed as severe, medical intervention may be necessary. The surgery is usually performed by a pediatric urologist. The most common procedure performed to correct hydronephrosis is pyeloplasty. Pyeloplasty involves removing narrowed or obstructed parts of the ureter and then reattaching it to a healthy part of the drainage system. The success rate and outcome of pyeloplasty is about 95%. There are times when other surgeries may be necessary.

Fetal surgery
There are rare cases where prenatal hydronephrosis is so severe that it puts the life of the fetus in danger. Typically, this means there is an increased risk of low amniotic fluid (a condition called oligohydramnios), blockage in the baby's ureter, blockage of the bladder and both kidneys.

The most reliable surgical intervention on the fetus is a procedure similar to amniocentesis. Using ultrasound guidance, surgeons insert a shunt (small tube) through a large needle inserted through the mother's abdomen directly into the baby's enlarged bladder. The shunt allows urine that has accumulated in the bladder to drain into the amniotic cavity.

Even after fetal intervention, the baby will likely still need some kind of surgical treatment after birth to ensure normal bladder drainage and protect kidney function.

Surgical treatment
Surgery is usually only necessary for severe hydronephrosis, but it may sometimes be an option for some children with moderate hydronephrosis. The goal of the surgery is to reduce swelling and pressure in the kidney by restoring the free flow of urine.

When talking about a surgical procedure, the most commonly mentioned is pyeloplasty, which removes the most common type of blockage that causes hydronephrosis in the ureteral- pelvis segment. After surgery, children usually remain in the hospital for about three days and complete recovery occurs in about two to three weeks; the success rate is about 95%.

Surgical treatment using robotics
Robotic pyeloplasty is a laparoscopic (minimally invasive) procedure in which surgeons operate using a tiny camera and very thin instruments inserted into three to four small incisions. Although it takes longer to perform than open surgery, robotic pyeloplasty accomplishes the same goal: removing the diseased portion of the ureter and reattaching the healthy portion to the kidney. Robotic surgery also offers a number of benefits, including:

Less postoperative discomfort.
Fewer scars and their small size.
Shorter postoperative hospital stay (usually 24 to 48 hours)
Faster recovery and ability to return to full activity sooner

Hydronephrosis in adults

Causes of hydronephrosis

Hydronephrosis most often occurs as a result of internal blockage of the urinary tract or any reason that interferes with its normal functioning.

Common reasons

Kidney stones are a common cause of hydronephrosis in men and women. Sometimes a stone passing from the kidney into the ureter can block the normal flow of urine.

Reasons for men

In men, there are two most common causes of hydronephrosis:

non-cancerous prostate tumor (benign prostatic hyperplasia)
prostate cancer

Both conditions can put pressure on the ureters, blocking the flow of urine.

Reasons for women

In women, the most common causes of hydronephrosis are:

pregnancy - during pregnancy, an enlarged uterus (womb) can sometimes put pressure on the ureters
cancers that develop inside the urinary tract, such as bladder cancer or kidney cancer
cancers that develop inside the reproductive system, such as cervical cancer, ovarian cancer, or uterine cancer

Abnormal tissue growth associated with cancer can put pressure on the ureters or impair bladder function.

Other reasons

Other, less common causes of hydronephrosis include:

blood clot (embolism) - which develops inside the urinary tract (the cause may be injury to the walls of these tracts)
Endometriosis is a disease where tissues that should grow only in the uterus begin to grow outside of it. This abnormal growth can sometimes interfere with the functioning of the urinary tract.
Tuberculosis is a bacterial infection that usually develops in the lungs, but in some cases can also spread to the bladder.
damage to the nerves that control the bladder (neurogenic bladder)
Ovarian cysts are fluid-filled sacs that develop inside the ovaries. Enlarged ovaries can sometimes put pressure on the bladder or ureters.
narrowing of the ureter due to injury, infection, or surgery.

Symptoms of Hydronephrosis in children and adults

Most newborns with hydronephrosis have no symptoms at all. Older children may also have no symptoms, and the condition may go away without any treatment.

Symptoms are almost the same for both children and adults.
If a child has a more serious form of hydronephrosis, one or more of the following symptoms may appear:

abdominal pain, nausea and/or vomiting, especially after large fluid intake.
pain in the side (just above the pelvic bone) slightly radiating to the back.
Hematuria (blood in the urine) – change in the color of urine.
urinary tract infections.

Symptoms of hydronephrosis will depend on how quickly the urine blockage occurs: quickly (acute hydronephrosis) or gradually (chronic hydronephrosis).

If the forms of blockage are rapid—for example, as a result of a kidney stone—symptoms will develop within a few hours. If the blockage develops gradually over several weeks or months, there may be few or no symptoms.

Symptoms can be more severe and depend on where the problem occurs, how long the urine has been blocked, and how much the kidney has been stretched.

Acute hydronephrosis

The most common symptom of acute hydronephrosis is severe pain in the back or side, between the ribs and hip. The pain will be on the side of the affected kidney or on both sides if both kidneys are affected. In some cases, the pain may travel to the testicles (in men) or the vagina (in women).
The pain usually comes and goes, but often the symptom gets worse after drinking liquids. In addition to pain, nausea and vomiting may also occur.

If the urine inside the kidney becomes infected, symptoms of a kidney infection may also occur:

high temperature (fever) of 38 °C and above.
uncontrollable shaking (chills).

If the urinary blockage was caused by kidney stones, you may notice the presence of blood in the urine. In severe cases of hydronephrosis, one or both of the kidneys may be noticeably swollen to the touch.

Chronic hydronephrosis

If hydronephrosis is caused by a blockage that develops over a long period of time, the following may occur:

the same symptoms as in acute hydronephrosis (see above).
no symptoms at all.
dull pain in the back that appears and disappears.
the patient may urinate less frequently than usual.

When should you see a doctor?

Always contact your doctor if you have:

severe and constant pain is felt
there are symptoms, such as a high temperature, indicating a possible infection
noticeable uncharacteristic changes in urinary frequency

Diagnosis of Hydronephrosis in adults

Diagnosis begins with talking about the symptoms the patient is experiencing. The doctor will ask guiding questions to find out if the patient needs further testing. Physical examination, medical history, and the patient's family history can be helpful in diagnosing hydronephrosis.

If acute onset of symptoms is noted, a physical examination may reveal tenderness in the flank or area where the kidneys are located. Examination of the abdomen may reveal an enlarged bladder. Typically, in men, a rectal examination is performed to assess the size of the prostate. In women, a pelvic examination may be performed to evaluate the condition of the uterus and ovaries.

Laboratory tests
Depending on which potential diagnosis is being considered, the following laboratory tests may be performed:

Urinalysis
Detects the presence of blood, infection or abnormal cells.
This is a very common test that can be performed in many health care settings, including doctors' offices, laboratories, and hospitals.

It is carried out by collecting a urine sample from the patient's body into a special container. Typically, a small amount (30-60 ml) of urine may be required for testing. The sample is examined at a medical clinic and may also be sent to a laboratory. Urine is visually assessed by its appearance (color, turbidity, odor, transparency), as well as using macroscopic analysis. An analysis can also be performed based on the chemical and molecular properties of urine and their microscopic evaluation.

General blood test
May detect anemia or potential infection.

A complete blood count is one of the most commonly prescribed blood tests. A complete blood count is a calculation of the formed elements of blood. These calculations are usually determined on special machines that analyze the various components of the blood in less than a minute.

The main part of a complete blood count is measuring the concentration of white blood cells, red blood cells and platelets in the blood.

How is a general blood test performed?
A complete blood count is performed by obtaining a few milliliters of blood sample directly from the patient. This procedure is performed in many places, including clinics, laboratories, and hospitals. The skin is wiped with an alcohol wipe and a needle is inserted through the area of cleaned skin into the patient's vein. The blood is drawn out by a syringe through a needle on the syringe or by using a special vacuum tube (which serves as a container for the blood) that is attached to the needle. The sample is then sent to a laboratory for analysis.

Blood electrolyte analysis
May be useful in chronic hydronephrosis, since the kidneys are responsible for maintaining and balancing their concentration in the blood.

Blood test for creatinine
Blood tests - which help assess kidney function.

Approximately 2% of creatine in the human body is converted to creatinine every day. Creatinine is transported through the blood to the kidneys. The kidneys filter out most of the creatinine and dispose of it in urine. Because muscle mass in the body is a relatively constant amount from day to day, creatinine production usually remains fairly constant on a daily basis.

Instrumental studies

Computed tomography
A CT scan of the abdomen may be performed to evaluate the kidneys and make a diagnosis of hydronephrosis. It can also allow the doctor to detect underlying causes, including kidney stones or other structures that are putting pressure on the urinary system and obstructing the normal flow of urine. Depending on the situation, a CT scan can be done with a contrast agent injected into a vein, or with an oral contrast agent that the patient takes by mouth before the test, which allows the intestine to be outlined later. But most often, for kidney stones, neither oral nor intravenous contrast is needed.

Ultrasound examination
Ultrasound is another test that is performed to detect hydronephrosis. The quality of the study results depends on the professional experience of the doctor performing the study, who must correctly assess the structures of the abdominal organs and retroperitoneal space. Ultrasound examination can also be used when examining pregnant women as it eliminates the effect of radiation on the fetus.

Degrees of Hydronephrosis

It is very important to see a doctor at an early stage of the disease. According to the severity of the disease, hydronephrosis can be divided into 3 degrees:

Mild degree - in which there will be minor reversible changes in the structure of the kidney, slight dilation of the pelvis, normal kidney function.
Medium degree - at which there will be relatively significant changes in the structure of the kidney, a fairly strong expansion of the pelvis, thinning of the walls of the kidney, and an increase in the size of the kidney by 15-25%. Kidney function is significantly reduced, compared to the function of a healthy kidney by approximately 25-40%.
Severe degree - in which severe, sometimes irreversible changes in the structure and function of the kidney appear. The kidney greatly increases in size - up to 2 times. The renal pelvis is very dilated, kidney function is critically reduced or absent.

Treatment adults

If a patient is diagnosed with hydronephrosis, treatment will depend primarily on the cause of the condition and the severity of the blockage of urinary flow.
The goal of treatment is to:

remove urine accumulation and relieve pressure on the kidneys
prevent irreversible kidney damage
treating the underlying cause of hydronephrosis

Most cases of hydronephrosis require surgical treatment using a combination of different methods.

The timing of the patient's treatment will depend on whether he has an infection, because there is a risk of the infection spreading into the blood, causing blood poisoning or sepsis, and this can be very dangerous for the patient's life. In these conditions, experts often recommend surgery on the same day when the diagnosis is fully confirmed.
Immediate surgery may also be recommended if both of the patient's kidneys are affected or if the patient has symptoms such as severe pain, vomiting and nausea that cannot be relieved with medication.
If the patient does not have these symptoms, then his condition can be considered conditionally safe to delay surgery for several days.

Drug treatment

Drug treatment for hydronephrosis is limited and is used to treat pain and prevent or treat infection (antibiotic therapy). However, there are 2 exceptions - oral alkalizing therapy for urolithiasis, and steroid therapy for retroperitoneal fibrosis.

Any drug treatment for hydronephrosis must be agreed upon and prescribed by a specialist doctor.
Urine diversion
The first step in the treatment of hydronephrosis is to drain urine from the kidneys. This helps relieve the patient's pain and prevents kidney damage.

A catheter (thin tube) is inserted into the bladder through the urethra or directly into the kidneys through a small cut in the skin. This allows urine to flow freely and reduces pressure on the kidneys.

Treating the underlying cause

Once the pressure on the kidneys is relieved or completely relieved, the cause of urine accumulation should be eliminated. This usually involves removing the cause of the tissue blockage.

Blockage of the ureter (a common cause of hydronephrosis) is treated with a procedure called ureteral stenting. It involves placing a small tube inside the ureter to "bypass" the blockage. A stent can be placed in the ureter without the patient having to make large incisions on the body.
Once the urine has been drained and the ureter is unblocked, the underlying cause must be treated to prevent hydronephrosis from reverting.

Some possible causes and their treatment are described below.

Kidney stones - can be broken up using sound waves or a laser.
enlargement (tumor) of the prostate - can be treated with medication or, in rarer cases, surgery to remove some or all of the prostate.
Cancers - Some types of cancer, such as cervical cancer, prostate cancer, which are associated with hydronephrosis, can be treated with a combination of chemotherapy, radiation therapy and surgery to remove the affected tissue.

Diet for Hydronephrosis

In case of hydronephrosis, the diet will be based on the requirements prescribed for the disease or cause that caused hydronephrosis, that is, it will be specific for each individual case. However, there are a number of unified rules for nutrition during hydronephrosis that should be followed:

Moderate water consumption - up to 2 liters per day
Maximum reduction in table salt consumption, no more than 2 grams per day; it is better to give up salt altogether, and if possible replace it with lemon juice.
You should eat fresh vegetables in the form of salads.
It is recommended to exclude from the diet such foods as: fatty meat, sea fish, legumes, smoked meats, sausages, meat sauces, chocolate and coffee.

Forecast at hydronephrosis

The prognosis for a patient with hydronephrosis depends entirely on timely seeking help from specialists, as well as on timely treatment. Usually, with timely treatment, the percentage of recovery and absence of consequences reaches 95%. If you contact a doctor late, there is a possibility of losing a kidney or acquiring kidney failure, which is an extremely serious blow to the physical, mental and financial condition of the patient, as well as his family. That is why systematic and regular visits to clinics are necessary, as well as periodic laboratory and instrumental studies for preventive purposes.

How to treat hydronephrosis during pregnancy?

If hydronephrosis is caused by a woman's pregnancy, there is little that can be done to treat it other than waiting for the pregnancy to progress naturally. However, the condition can be managed by regularly draining urine from the kidney through a catheter throughout pregnancy to prevent kidney damage.

What is fetal hydronephrosis?

Fetal hydronephrosis is also called prenatal or antenatal (translated as before birth) hydronephrosis - this means that the disease developed and was detected before birth. Hydronephrosis is an expansion of the renal pelvis and/or an increase in the size of the kidney due to impaired urine outflow. This condition occurs in approximately 1-5% of cases. Antenatal hydronephrosis is detected in the fetus during routine ultrasound examinations, usually in the first trimester of pregnancy. In most cases, no specific prenatal care or treatment will be required, but monitoring by a doctor or, in some cases, surgery after birth may be required.
Typically, the causes of fetal hydronephrosis can be:

Blockage – can occur at the junction of the kidney and ureter, at the junction of the bladder and ureter, or in the urethra (urethra). If a blockage occurs, surgery will most likely be required.
Vesicoureteral reflux – This condition is a malfunction of the valve between the ureter and bladder, which normally prevents urine from flowing from the bladder back into the ureter and kidney. Approximately 70-80% of children born with this diagnosis grow up and this disorder goes away on its own, but constant monitoring by a doctor is usually necessary and antibiotics may be used so that if urine gets back into the ureter and kidney, it does not cause infection. Surgery may be required if infection does occur or the reflux problem does not go away on its own.

If fetal hydronephrosis has been diagnosed and there are no complications, then most likely you will only need regular ultrasound examinations. Typically, fetal hydronephrosis does not affect the course of pregnancy; in extremely rare cases, severe renal obstruction may require a cesarean section during childbirth.

What is hydronephrosis of the newborn?

Hydronephrosis of the newborn or postnatal hydronephrosis is a consequence of antenatal (prenatal) hydronephrosis. Hydronephrosis is an expansion of the renal pelvis and/or an increase in the size of the kidney due to impaired urine outflow. In most cases, the cause is a blockage of the urinary tract (the ureter at the junction with the kidney or bladder, as well as a blockage of the urethra) or, in rarer cases, vesicoureteral reflux (a malfunction of the valve between the ureter and bladder that prevents urine from flowing back into the ureter and a kidney from the bladder). Usually, hydronephrosis is detected in the fetus during pregnancy thanks to an ultrasound examination, and doctors are ready to make the right choice of the necessary treatment and observation.

After birth, usually on the third day, an ultrasound examination of the newborn is performed to determine the condition of the internal organs, as well as to determine the presence of hydronephrosis. If hydronephrosis persists after birth, a cystourethrogram or kidney scan will be required to determine the cause of the hydronephrosis. A kidney scan is preferred as it provides more accurate results. As already mentioned, the main causes of hydronephrosis are blockage of the urinary tract or vesicoureteral reflux. In the case of vesicoureteral reflux, treatment is limited to antibiotic therapy (to prevent kidney infection by allowing urine from the bladder to flow back into the ureter and kidney) and regular follow-up with a doctor with periodic ultrasound examinations to monitor the reflux condition. In most cases, as the child grows up, vesicoureteral reflux goes away on its own. If a blockage occurs, surgical treatment will most often be required. In some cases, when the blockage is minor, it is possible to observe for 6 months and then re-examine; in the case of a favorable course, it is possible to avoid surgical intervention.

Pathophysiological features and clinical signs of urinary tract obstruction are given in Table. 230-2. The appearance of pain is the symptom that most often forces the patient to seek medical help. Pain from urinary tract obstruction is caused by stretching of the collecting system or renal capsule. The severity of pain is influenced more by the speed of stretching, rather than by its degree. Acute supravesical obstruction caused by a stone lodged in the ureter (Chapter 229) causes excruciating pain, usually called renal colic. These pains are quite persistent in nature with slight fluctuations in intensity and often radiate to the lower abdomen, testicles or labia. More slowly developing processes that cause obstruction, such as chronic narrowing of the ureteropelvic junction, cause little or no pain and may still result in total destruction of the affected kidney. Flank pain that occurs only during urination is a pathognomonic sign of vesico-ureteral reflux.

Table 230-1. Mechanical causes of urinary tract obstruction

Ureter

Bladder outlet

Urethra

Congenital

Narrowing or obstruction of the ureteropelvic junction Narrowing or obstruction of the ureterovesical junction

Ureterocele

Retrocaval ureter

Bladder neck obstruction

Ureterocele

Posterior urethral valves

Anterior urethral valves

Stricture

Stenosis of the external urethral meatus

Acquired defects inherent in the urinary tract itself

	Benign prostatic hypertrophy	Stricture
Inflammation

Severed papilla	Prostate cancer

Blood clots	Diabetic neuropathy
Uric salt crystals	Diabetic neuropathy
	Spinal cord disease

Acquired defects external to the urinary tract

Pregnant uterus Ormond's disease	Cancer of the cervix, colon
Aortic aneurysm
Leiomyoma of the uterus
Cancer of the uterus, prostate, bladder, colon, rectum
Lymphoma in the retroperitoneum
Accidental ligation of the ureter during surgery

Table 230-2. Pathophysiology of bilateral ureteral obstruction

Azotemia with urinary tract obstruction develops if the excretory function is completely impaired. This can occur with obstruction of the bladder outlet, bilateral obstruction of the renal pelvis or ureters, or with their unilateral damage in a patient with one functioning kidney. Complete bilateral obstruction is possible if acute renal failure is accompanied by anuria. Any patient with otherwise unexplained renal failure or a history of renal stones, hematuria, prostate enlargement, pelvic surgery, trauma, or tumor should be evaluated for urinary tract obstruction.

Symptoms such as polyuria and nocturia usually accompany chronic partial obstruction of the urinary tract and develop as a result of impaired concentrating ability of the kidney. It is usually not possible to eliminate this disorder by administering exogenous vasopressin, and therefore it represents a form of acquired nephrogenic vasopressin-resistant diabetes insipidus. Disturbances in the transport of sodium chloride in the ascending limb of the nephron (in patients suffering from azotemia) and osmotic (urea) diuresis through the nephron lead to a decrease in the hypertonicity of the renal medulla and, consequently, to a violation of their concentrating ability. Therefore, partial obstruction of the urinary tract may be accompanied by an increase, rather than a decrease, in the volume of urine output. In fact, large fluctuations in urine output in an azotemic patient should always increase the likelihood of intermittent or partial urinary tract obstruction. If the intake of fluid into the body in such patients is insufficient, they may develop severe hypohydration and hypernatremia. Patients with obstruction of the urinary tract at or below the level of the bladder usually complain that they need to strain at the beginning of urination, after the end of urination, dribbling of urine, frequent urge and urinary incontinence (feeling of fullness of the bladder) are noticed (chapter 40). ).

In addition to impaired renal concentrating ability and the development of azotemia, partial bilateral urinary tract obstruction often leads to other disorders of renal function, including acquired distal renal tubular acidosis, hyperkalemia, and excess salt excretion. The morphological changes accompanying these dysfunctions of the tubules are characterized by extensive tubulointerstitial damage to the kidneys and appear in the early stages of obstructive disorders. First, interstitial edema and its infiltration by inflammatory mononuclear cells develop, then interstitial fibrosis; wrinkling and atrophy of the papillae and medulla, preceding the development of the same processes in the renal cortex.

The possibility of urinary tract obstruction should always be considered in patients with a urinary tract infection or renal stone disease. Urostasis promotes the proliferation of microorganisms and the formation of crystals, especially crystals of mixed magnesium and ammonium phosphate salts (struvite). In acute and subacute cases of unilateral obstruction, hypertension is often observed, resulting from increased release of renin by the affected kidney. Chronic unilateral or bilateral hydronephrosis with an increase in the volume of extracellular fluid or other kidney diseases can lead to the development of severe hypertension. Polycythemia, a rare complication of obstructive uropathy, is likely secondary to increased production of erythropoietin in the affected kidney.

Urinary tract obstruction is a pathological condition in which the outflow of urine is impaired. Obstruction can occur at any level of the urinary system, from the kidneys to the urethra. According to statistics, the pathology is more often diagnosed in people over 50 years of age.

Urinary tract obstruction can be either congenital or acquired. In the first case, a delay in the outflow of urine is provoked by various developmental anomalies, for example:

narrowing of the bladder neck;
protrusion of the urethral wall - diverticulum;
abnormal narrowing of the ureters;
phimosis;
polypous growths;
ureterocele - spherical protrusions on the walls of the ureter;
abnormal development of the anterior and posterior valves of the urethra.

The following pathologies can be the causes of the acquired form of obstruction:

tumors in the urinary system and nearby organs;
disruption of the nervous system (diabetic neuropathy);
fibrosis;
cervical fibroids;
blood clots in the ureter;
hernias;
kidney hydronephrosis;
inflammatory processes in the pelvic organs;
pregnancy (compression of the ureter by the uterus);
urolithiasis;
movement of stones from the kidneys to the ureter;
prostate adenoma;
urethral trauma.

Obstruction of the urinary system can develop in both acute and chronic forms. In addition, the pathology can be either unilateral or bilateral, depending on whether 1 kidney or both are affected.

According to statistics, in older people the cause of obstruction is most often tumors, in children - congenital anomalies, and in young people - urolithiasis.

Clinical picture

Often, obstructive blockage of the urinary tract develops asymptomatically. And the first signs appear against the background of an advanced inflammatory process. When symptoms are present, their intensity primarily depends on the location, degree and form of obstruction, for example:

the chronic form of the pathology is often accompanied by painful sensations in the side and frequent urge to urinate;
with acute obstruction, there is an increase in fluid pressure, which results in stretching of the kidneys, bladder or ureter, accompanied by acute pain;
if the obstruction is accompanied by blockage of the canal with stones, then sudden attacks of sharp pain occur (renal colic);
when an infection enters the bladder, the body temperature rises, traces of blood and pus may be present in the urine;
With congenital anomalies, digestive system disorders often occur, for example, vomiting, nausea, diarrhea.

Pain is one of the first signs of pathology. If it appears, you should immediately consult a doctor. Obstruction can be suspected in the early stages in patients with a history of urolithiasis or infectious diseases of the urinary system.

Diagnostic methods

To make a correct diagnosis, you should consult a urologist. After a complete history collection, the doctor will write out directions for studies such as:

cystoscopy;
Ultrasound of the abdominal cavity and pelvic organs;
general and biochemical blood tests;
urine test;
computed tomography (CT);
fluoroscopy;
bladder catheterization;
excretory urography.

An ultrasound will allow the doctor to assess the condition of the kidneys, gall and bladder, and uterus. The examination will help determine the presence of stones, polyps and other pathological changes in the kidneys.

The bladder is examined using cystoscopy. The procedure is carried out under anesthesia using a special apparatus - a cystoscope. During excretory urography, a contrast agent is injected into the patient's bloodstream. X-rays are then taken to identify areas of obstruction.

Computed tomography allows you to identify tumors or stones; unlike conventional fluoroscopy, a picture of the organ is displayed in a three-dimensional image. A urine test shows its chemical composition and helps evaluate kidney function. Catheterization of the bladder is not only carried out for diagnostic, but also for therapeutic purposes: in cases where it is necessary to ensure the forced outflow of urine through the urethra.

Treatment and possible consequences

The therapeutic course for urinary tract obstruction is primarily aimed at eliminating the cause that provoked the pathology. When the canal is compressed by a tumor or enlarged prostate, doctors prescribe hormonal therapy. Treatment with medications is also carried out in cases where obstruction is caused by dysfunction of the urinary system.

In order to avoid pressure due to excess fluid in the body, catheterization of the ureter or bladder is performed. After forced drainage of fluid, the patient is often prescribed a course of broad-spectrum antibacterial drugs. This measure is necessary to reduce the risk of developing infectious processes.

Surgery is performed in the presence of polyps, large tumors or scars that impede the stable flow of urine. In addition, surgery may be required if the patient:

renal failure;
relapse of the infectious process;
kidney stones that cannot be crushed.

In case of acute renal failure, the patient has the affected kidney removed. In some cases, radiation therapy is used to relieve obstruction.

Timely excretion of urine is one of the important elements of normal life. With urine, waste products, breakdown products, and excess fluid are removed from the body. Any difficulties with the outflow of urine result in serious illness. Infravesical obstruction is one of the ailments that disrupts the urinary outflow mechanism.

Bladder bladder obstruction

Urine is not released constantly. In a hollow muscular organ - the bladder, a certain volume of it accumulates and is then excreted. On average it is 300 ml, although the urea is able to hold up to 700 ml of liquid.

The flow of urine is regulated by the circular muscles - sphincters, and the detrusor muscle of the bladder. The accumulated fluid puts pressure on the walls of the organ. They stretch, and receptors in the muscle layer transmit a signal to the brain. As a result, the urge to urinate appears.

Normal urine output is ensured by the coordinated work of the urinary tract and sphincters. When emptying, the sphincter relaxes and stops blocking the canal. The bladder muscles, on the contrary, contract and form the flow of urine. Other muscles are also involved in the process, but their role is not so significant.

Violation of this mechanism is possible for a variety of reasons and in different ways. Thus, bladder outlet obstruction involves some obstruction to the outflow of fluid at the level of the cervix or urethra.

The cause may include birth anomalies, hypertrophy, and other factors. All of them lead to disruption of normal urine output, or even to complete delay.

In most cases, the cause of obstruction is anomalies in the development of the organ. Therefore, this disease is much more often observed in children, sometimes from birth. Boys get it much more often, since girls, due to their anatomical structure, have fewer reasons for the formation of infravesical obstruction. In men and women, the pathology is extremely rare.

Difficulties with urine output lead to distension of the bladder, atony and. In addition, unremoved urine residues are an excellent breeding ground for bacteria, which provokes the development of many infectious diseases.

Reasons

Most often, the disease occurs as a result of congenital anomalies. The most common include sclerosis of the bladder neck and congenital valves, but there are other pathologies that lead to the same result.

Cervical sclerosis– congenital contracture or Marion’s disease. It is expressed as the development of the fibrous ring in the muscular layer of the cervix and in the submucosal layer. Unlike muscle tissue, fibrous tissue does not have elasticity and, accordingly, does not ensure proper functioning of the sphincter. In older children, the disease is accompanied by chronic inflammation. Contracture is accompanied by disturbances in the outflow of urine, paradoxical, disturbances in the functioning of the kidneys, up to renal failure. Treatment requires surgery.

Hypertrophy of the spermatic tubercle– excessive growth of all elements of the seminal tubercle. The latter exerts mechanical pressure on the cervix or urethra and prevents the normal outflow of urine. The signs coincide with the picture with. Boys of adolescence and older also experience pain during erection. Treatment consists of surgery.

Congenital narrowing of the urethra– observed in the distal urethra. At the same time, the proximal part of the urethra is expanded. In girls, the diagnosis of such a disease should be accompanied by a thorough check, since the symptoms of the disease are close to urethral stenosis, and the signs of the disease themselves are quite vague. In addition, due to the structure of the female urethra, diagnosing such a disease is difficult. Treatment is limited to the urethra.

Congenital valves- The anomaly is quite rare. In boys it appears in a ratio of 1:50 thousand, in girls it is extremely rare. Its essence boils down to the formation of membranes in the urethra in children, covered with a mucous membrane. There are 3 types of membranes: cup-shaped, funnel-shaped and in the form of a diaphragm placed across the channel.

Regardless of the type, the symptoms of the disease are the same: difficulties with outflow, pain, difficulty in completely emptying the bladder, and so on.

Duplication of the urethra– only possible for boys. The double urethra has a variety of forms: from an additional canal emerging on the head or shaft of the penis, to blind passages located parallel to the existing canal.

Urethral diverticulum– protrusion of the rear walls of the canal, forming a kind of sac-like container. The diverticulum retains urine, which is removed from the bladder in the usual way. If you press on the diverticulum, it can be felt through the rectum, it empties, and urine or pus flows down the urethra. Congestion in the diverticulum leads not only to painful urination, but also to infection, the appearance of stones, and abscesses. The diverticulum is excised during surgery.

Congenital canal obliteration– urine is released through a congenital fistula. It is extremely rare and, as a rule, is combined with other anomalies that are incompatible with life. Diagnoses by the absence of urine in a newborn for 2 days. For treatment, cystotomy is performed.

Manifestations

If the disease is not associated with pronounced anomalies, the presence of which is quickly established in newborns, then it is diagnosed according to the following criteria:

increased urge;
periodic incontinence;
pain and discomfort when emptying the bladder;
incomplete release of the bladder, to the point that urination is possible only with mechanical pressure on the organ;
lack of pressure - the stream is weak and intermittent.

Such signs are inherent in quite a few genitourinary ailments, which makes diagnosis very difficult. In most cases, bladder outlet obstruction can be established only after a thorough hardware examination.

The disease develops in stages. Moreover, the stages are not associated with a mechanical cause - valves, cervical sclerosis, but with the changes that they cause in the bladder:

at stage 1, only the muscular layer of the urinary tract is affected, but tone is not yet lost. In this state, urination is only slightly difficult, but is not accompanied by pain, and the bladder is emptied completely;
at stage 2, the tone of the organ decreases, as its walls stretch excessively. That is, the bladder can no longer contract sufficiently to empty itself. The urine stream becomes weak, interrupted, and it is not possible to completely empty the bladder, which leads to stagnation of urine and infection;
At stage 3, atony occurs. The bladder loses its ability to contract, which practically blocks urinary flow. In this case, spontaneous uncontrolled removal of fluid may occur.

Necessary examinations

Differential diagnostics are required, since it is difficult to accurately establish the true cause of the disorders.

Collecting anamnesis - it is necessary to collect as accurate information as possible, indicating the time of appearance of a particular symptom. As a rule, this is difficult to do, since young patients have poor time orientation.
Physical examination - in some cases, examination and palpation can provide preliminary results. For example, a diverticulum can be felt as a dough-like tumor that empties when pressed.

Laboratory tests include:

general blood test - the disease is accompanied by an increased number of leukocytes in the blood, accelerated ESR;
biochemical blood test - there is an increase in the level of creatinine and urea in the blood, the concentration of calcium, sodium, potassium ions increases;
general urinalysis - signs are usually observed, leukocytes and red blood cells are found in the urine;
enzyme immunoassay of blood - an increase in parathyroid hormones is noted.

The basis of diagnosis for bladder outlet obstruction is instrumental methods:

and kidneys - allows you to determine the degree of organ damage. With obstruction, thickening of the detrusor is observed, urine remains, and the contours of the bladder become unclear. Often the disease is accompanied by cystitis, and with a long course - pyelonephritis;
Dopplerography of the renal vessels - with obstruction, the blood flow is impaired and the cause can be determined by the nature of the disorder;
– when a contrast agent is administered, the bladder and kidneys are examined using x-rays. For cervical contracture, for example, the site of narrowing of the cervix is examined and the speed of fluid movement is assessed. With congenital valves, the expansion of the channel above the site of valve formation is determined;
cystourethrography - the condition of organs is examined with an optical device. In this case, fundus elevation, signs of neurogenic dysfunction of the urethra, expansion of the posterior part of the urethra, trabecularity of the walls of the urethra, and so on are detected;
uroflowmetry - studies the speed and volume of urine flow during urination. Despite its simplicity, this is a fairly informative method, since the nature of the obstacle can be determined by the nature of the intermittency of the stream and its fullness;
if necessary, histological studies are prescribed, especially for older children, to exclude or identify additional inflammatory processes.

Treatment

The first task in case of obstruction is to ensure normal flow of urine. Depending on the nature of the disease and the degree of its development, nephrostomy, urethrostomy, clustering of the bladder and ureter are used.

Infectious or inflammatory diseases are then treated. Very rarely the disease is not accompanied by at least inflammation. After the infection has been suppressed, elective surgery is performed.

Surgery is the only treatment for bladder outlet obstruction. The nature of the operation depends on the type of disease:

in case of congenital sclerosis of the cervix, a longitudinal dissection of the cervix and subsequent suturing of the urethra - Y-shaped plasty - are prescribed. Transurethral resection of the neck has also become widespread;
congenital valves are removed using transurethral resection;
hypertrophy of the seminal tubercle suggests endourethral resection;
if the obliteration of the canal is congenital, then cystostomy is performed - dissection of the urinary tract along the anterior wall. If the zones are not too large, then parts of the urethra are excised and stitched in order to restore normal urine flow;
with congenital narrowing of the urethra, treatment is determined by the degree of narrowing. If the symptom does not lead to loss of tone in the bladder, bougienage of the urethra is performed - insertion of a dilating device into the urethra. In case of stenosis, dissection of the external opening of the urethra is undertaken;
doubling the canal requires radical measures: the additional passage is excised;
congenital diverticulum is surgically removed immediately after diagnosis;
Urethral cysts and any abnormal changes must also be removed.

In some cases, for example, with compression of the urinary canal, they try to cure the disease with medication - with the help of M-cholinergic stimulants.

Prevention

In most cases, obstruction is caused by developmental abnormalities. Accordingly, it is impossible to take any preventive measures for such a disease.

Complications

Infravesical obstruction is a very dangerous disease. Firstly, it can only be treated surgically, which excludes self-healing options. Secondly, difficulties with urination result in very serious consequences:

obstruction to the outflow of urine initially leads to hypertrophy of the muscular lining of the bladder, as the organ tries to contract more strongly in order to push urine out;
at later stages, the inability to perform their functions causes hypotension and urinary atony. As a result, the ability to empty itself is lost;
neurogenic bladder dysfunction develops;
stagnation of urine leads to the appearance of a variety of infectious diseases;
due to the pathological condition of the bladder, ureteral reflux develops, which causes chronic pyelonephritis, chronic cystitis, and renal failure.

Infravesical obstruction is a serious and dangerous disease. It is most often observed in children, since it is usually caused by developmental abnormalities. Treatment is possible only through surgery.
In the video about the causes, treatment and consequences of bladder outlet obstruction in children: