Represents the ureter. Ureteral stones: symptoms in women and treatments

06.03.2020

A complex disease in which stones fall into the ureter is always accompanied by severe pain. This pathology is dangerous for its complications if adequate treatment is not undertaken in a timely manner. Doctors, calling this ailment ureterolithiasis, give it the second most common urological practice. Pathology can be found in children. It is most often diagnosed in men. But sometimes they are found in the fair sex. Symptoms in women usually indicate a severe course of the disease.

Characteristics of pathology

Urolithiasis is a fairly common disease. Its appearance is provoked by many different factors. Most often, pathology occurs against the background of poor nutrition and unsatisfactory quality drinking water... Initially, stones form in the kidneys.

For a long period of time, most patients are not even aware of the presence of calculi. After all, the signs of the disease do not appear immediately. Meanwhile, calculi "grow" in the kidneys. And as a result of certain factors, stones in the ureter may appear.

What are the symptoms in women? This is, first of all, the strongest pain. It indicates (indicates the lowering of the calculus into the ureter). In such situations, you must immediately consult a doctor.

Penetration of a stone into the ureter

Concrements, as a rule, are formed in However, there are cases when stones were formed in the ureter. Symptoms in women, treatment - these are points that must be discussed with a doctor. An independent fight against pathology is completely unacceptable.

So, if a calculus forms in the kidneys, why does it end up in the ureter? Many different factors can provoke this movement. Most often this happens as a result of the following reasons:

carrying weights;
long shaking ride;
copious intake of fluids and food;
horseback riding.

It is very important to remember what signs appear if stones are localized in the ureter. Symptoms in women, indicating the advancement of calculus, appear in the form of severe pain syndrome. Acute discomfort appears in the abdomen and back. This condition is called renal colic.

The causes of the onset of the disease

Ureteral calculi are formed from various substances:

uric acid;
cystine;
struvite.

Most often, the following factors influence the process of stone formation:

Genetic predisposition. Doctors say that the disease is more often diagnosed in patients who have cases of urolithiasis in their family.
Disturbed outflow, stagnation of urine. The development of the disease may be based on congenital pathologies. Most often, the ailment is provoked by narrowed ureters in women, their underdevelopment, kinks or anomalies of the bladder.
Diseases of the urinary tract in a chronic form. Diseases of an infectious nature can lead to the development of pathology. For example, pyelonephritis.
Disrupted exchange. Acquired or congenital ailments can be accompanied by the penetration of lithogenic substances into the urine - calcium (if hyperparathyroidism is diagnosed), urates (in case of gout).
Diseases digestive system... If the function of absorption is impaired, calculi may form.
The use of drugs. Some medications can lead to the development of the disease. For example, such consequences are provoked by uroseptics from the category of nitrofurans.

Doctors say that uroliths are often formed in women living in hot and dry climates. High-calorie food rich in animal proteins is capable of starting the mechanism of the development of the disease.

Symptoms of the disease

There are times when stones in the ureter do not cause severe pain. Symptoms in women that characterize the movement of a calculus depend entirely on its size and shape. Stones not exceeding 2 mm in diameter are able to painlessly move along the ureter. In this case, no symptoms may be observed. The woman will not even know about the unpleasant pathology in the body.

But most often there are large stones in the ureter in women. Signs of pathology provoke stuck calculus.

In this case, the symptoms are pronounced and are called renal colic:

Sharp, strong pain, localized in the lumbar region. She gives in women to the perineum and labia.
Urination may be impaired. But such a sign is extremely rare and characterizes the simultaneous exit of stones from both ureters. Most often, women experience frequent urge to urinate.
The urine contains blood and internal epithelium of the kidney. Such symptoms appear as a result of damage to the ureter by the sharp edges of the calculus. If the stone completely blocked the path, then there will be no such sign, since urine flows only through a normal, unaffected ureter.
Hanging sweating, chills. There is an increase in temperature up to 37-37.5 degrees. Pathology can be accompanied by nausea, flatulence, and often vomiting.

The calculus, as a rule, advances periodically. This leads to the fact that painful symptoms in a woman appear and disappear. Such colic can be annoying for several hours or days.

Symptoms of pathology, depending on the localization of the calculus

Most often, a calculus is found at the site of narrowing of the ureter. This is the area where the renal pelvis connects to the canal. This area is called the pyeloureteral segment. The next area in which a stuck stone is often diagnosed is the area of \u200b\u200btransition of the ureter from the large pelvis to the small one. Another "dangerous" area is the junction of the canal with the bladder.

If the calculus clogs the ureter in the upper zone in women, the symptoms are as follows:

severe pain appears in the lower back;
acute discomfort is wavy in nature, then subsiding, then intensifying;
change in body position does not reduce the intensity of pain;
discomfort covers the sides of the abdomen.

The localization of the stone in the middle zone of the canal is evidenced by the following signs:

pain is acutely felt in the lateral region of the abdomen (below, along the edge of the ribs);
discomfort extends to the groin and ileum.

If the calculus has descended into the lower part of the ureter, then the woman's symptoms appear as follows:

pain is localized in the lower abdomen and groin area;
the strongest discomfort covers the outer labia;
urination becomes more frequent;
there is a feeling of fullness of the bubble;
the process of urination does not bring relief (the feeling of emptying does not appear).

Possible complications

It is very dangerous if long time there are stones in the ureter. Symptoms in women, treatment of pathology require a serious and responsible attitude.

Otherwise, serious consequences may develop, such as:

hydronephrosis;
acute renal failure;
fistulas in the ureter;
obstructive pyelonephritis.

Diagnostic methods

To make sure that severe discomfort provoked by the movement of the calculus along the ureter, the doctor will initial inspection... It involves palpation.

Then the patient will be assigned more accurate studies:

urine analysis that determines protein, salt, pus, blood cells;
bacterial sowing;
urine analysis to study its acidity;
x-ray examination;
blood test;
urography;
Ultrasound of the urinary tract;
CT of the kidneys;
radioisotope diagnostics.

The complex of such examinations allows you to determine the place of localization of the calculus, identify the sources of the disease and select adequate therapy.

Treatment methods

If, during the diagnosis, stones in the ureter in women are detected, only a competent specialist can decide how to remove them.

Treatment methods depend on the complexity of the situation, the size of the calculus. Depending on these factors, they can develop in 2 directions:

Conservative expectant therapy. It is undertaken in cases where the stone does not exceed 2-3 mm in diameter and does not block the duct. In this case, the possibility of an independent exit of calculus is high.
Active treatment. It is used if conservative therapy is impossible or did not give positive results.

Drug treatment

How to remove a stone from the ureter?

Conservative expectant therapy includes:

Prescription of urolytic drugs. Medicines "Nifedipine" or "Tamsulosin" provide acceleration of the passage of stones.
The use of painkillers, antispasmodics. Often, the patient is recommended NSAIDs, such as "Ibuprofen", "Naproxen".
A woman is prescribed physiotherapy and special physiotherapy exercises.

Diet

Diet therapy will be of particular benefit. It is based on the elimination of foods that contribute to the formation of stones in the body, and recommends an increase in food intake that accelerates the removal and dissolution of stones.

Refuse food containing oxalic acid (cabbage, spinach, nuts, currants, legumes).
Do not combine the above food with calcium-rich dairy products.
Include vitamin A-rich foods (broccoli, carrots, pumpkin) in your diet.
Have a fasting day (watermelon or cucumber) every week.
Establish a drinking regime. Drink about 2 liters of water daily.

Why do you need specialist help?

Sometimes the conservative therapy described above is ineffective, and ureteral stones are still diagnosed. It is important to discuss symptoms in women, removal of calculus with a professional urologist. It is strictly forbidden to fight the disease on your own.

Self-treatment can lead to rather sad consequences. Infection often appears among such complications. urinary tract... And this is a direct path to the development of sepsis. Unfortunately, in advanced situations, the patient may even be prescribed the removal of the ureter, and sometimes the kidney.

Operative intervention

Most often, the following methods are used to eliminate a calculus stuck in the ureter:

Lithotripsy. Most effective method crushing stones. Moreover, he is less traumatic. Litrotripsy involves the remote crushing of stones using waves. The event lasts on average about 1 hour. It is performed in most cases without anesthesia.
Ureteroscopy. Such a removal of calculus is carried out using a special device introduced into the canal through the genitourinary system. Sometimes before the introduction of the urethroscope, the stones are pre-crushed with a laser. The intervention is performed under general or partial anesthesia.
Ureterolithotomy. it surgical intervention, which is justified with sufficiently large stones. During this operation, the calculus is removed through the dissection of the walls of the ureter. Of course, the procedure involves general anesthesia.

Ureteral stones are a serious pathology in which it is extremely dangerous to delay a visit to the hospital. The disease refers to severe ailments that can lead to disastrous results. Therefore, do not practice self-disposal of stones. Seek help from competent professionals.

The ureters are tubes that connect the organs that produce urine (kidneys) with an unpaired formation - the bladder, which stores and excretes it from the body.

The anatomy of the ureter includes:

its structure;
basic dimensions;
location in relation to surrounding organs;
features of blood supply and innervation.

The ureter in women has distinctive features only in the pelvic region. The rest of the structure is the same with the male.

Location in relation to organs and peritoneum

The exit from the kidney is formed by the narrowed opening of the pelvis. The mouth of the ureter is located inside the bladder. It passes through the wall and forms double-sided slit holes on the mucous membrane of the bladder. At the confluence of the upper part, a fold is formed, covered with a mucous membrane.

It is customary to distinguish between 3 sections of the ureter.

Abdominal - passes through the retroperitoneal tissue in the posterior wall of the abdomen, then goes along the lateral surface to the small pelvis, adjacent to the front of the psoas major muscle. The initial part of the right ureter lies behind duodenum, and closer to the pelvic region - behind the mesentery of the sigmoid colon.

The reference point for the left is the back wall of the bend between the duodenum and jejunum... In the zone of transition to the pelvic part, the right ureter lies behind the base of the mesentery.

Pelvic - in women, it is located behind the ovary, bending around the cervix from the side, goes along the wide ligament of the uterus, fits between the wall of the bladder and the vagina. In men, the ureteral tube passes outward and anterior to the vas deferens, passing through it, enters the bladder almost under the upper edge of the seminal vesicle.

The distal section (the most distant from the kidney) - passes through the thickness of the bladder wall. It is up to 1.5 cm long. It is called intramural.

In clinical practice, it is more convenient to divide the length of the ureter into three equal parts:

top;
medium;
bottom.

Dimensions

In an adult, the length of the ureter is 28-34 cm. It depends on growth, is determined by the height of the location of the kidneys when they are laid in the embryo. In women, the length of the organ is 2-2.5 cm shorter than in men. The right ureter is one centimeter shorter than the left because the location of the right kidney is slightly lower.

The lumen of the tube is not the same: constrictions alternate with areas of expansion. The narrowest parts are:

next to the pelvis;
on the border of the abdominal and pelvic regions;
when it flows into the bladder.

Here the diameter of the ureter is 2-4 mm and 4-6 mm, respectively.

In the diagnosis, pathological changes are determined segment by segment.

Segments are distinguished between the narrowed areas:

from above - pyelourethral segment;
section of the intersection with the iliac vessels;
lower - vesicoureteral segment.

The abdominal and pelvic parts of the ureter differ in lumen:

in the area of \u200b\u200bthe abdominal wall, it is 8-15 mm;
in the pelvis - uniform expansion, no more than 6 mm.

However, it should be noted that due to the good elasticity of the wall, the ureter is able to expand up to 8 cm in diameter. This ability helps to withstand urinary retention, congestion.

In cross section, the lumen of the organ looks like a stellate shape

Histological structure

The structure of the ureter is supported:

from the inside - by the mucous membrane;
in the middle layer - by muscle tissue;
outside - adventitia and fascia.

The mucous membrane consists of:

transitional epithelium, located in several rows;
plate containing elastic and collagen fibers.

The inner shell forms longitudinal folds along its entire length, which protect the integrity during stretching. Muscle fibers grow into the mucous layer. They allow you to close the lumen from the backflow of urine from the bladder.

The number 1 shows a multi-row transitional epithelium, the detection of cells in the urine sediment indicates pathology

The muscle layer is formed by bundles of cells running in the longitudinal, oblique and transverse directions. The thickness of muscle cells varies. Top part includes two muscle layers:

longitudinal;
circular.

The lower part is reinforced with three layers:

2 longitudinal (inner and outer);
the middle between them is circular.

Myocyte cells are connected by many bridges (nexuses). Between the bundles there are connective tissue fibers that pass here from the mucous membrane plate and adventitia.

Blood supply

The tissues of the ureter are nourished by arterial blood. The vessels lie in the adventitia (outer) shell and accompany it along the entire length, penetrate deep into the wall with small capillaries. Arterial branches extend at the top from the ovarian artery in women and the testicular in men, as well as from the renal artery.

The middle third receives blood from the abdominal aorta, internal and common iliac arteries. In the lower section - from the branches of the internal iliac artery (uterine, cystic, umbilical, rectal branches). The vascular bundle in the abdominal part passes in front of the ureter, and in the small pelvis - behind it.

Venous blood flow is formed by the veins of the same name, located in parallel with the arteries. From the lower section through them, blood flows into the branches of the internal iliac vein, and from the upper section to the ovarian (testicular).

Lymphatic drainage goes through its own vessels to the internal iliac and lumbar lymph nodes.

Features of innervation

The functions of the ureters are controlled by the autonomic nervous system through the nerve nodes in the abdominal and pelvic cavity.

Nerve fibers are part of the ureteral, renal and lower hypogastric plexuses. Branches fit to the top vagus nerve... The lower one has one innervation with the pelvic organs.

Reduction mechanism

The main task of the ureters is to push urine from the pelvis to the bladder. This function is provided by the autonomous contractile ability of muscle cells. In the pelvic-ureteric segment there is a pacemaker (pacemaker), which sets the required rate of contractions. The rhythm can change depending on:

horizontal or vertical position body;
filtration rate and urine formation;
"Indications" of nerve endings;
condition and readiness of the bladder and urethra.

Pushing urine is carried out by the activity of muscle cells

The direct effect of calcium ions on the contractile function of the ureters has been proven. The strength of contractions depends on the concentration in the cells of the smooth muscles of the muscle layer. A pressure is created inside the ureter that exceeds that in the pelvis and bladder... In the upper section, it is equal to 40 cm of water. Art., closer to the bladder - reaches 60.

This pressure is able to "pump" urine at a rate of 10 ml per minute. The general innervation of the ureter with the adjacent part of the bladder creates conditions for the coordination of muscular efforts of these organs. The pressure in the bladder "adjusts" to the ureteral pressure, therefore, under normal conditions, urinary backflow (vesicoureteral reflux) is prevented.

Features of the structure in childhood

In a newborn child, the length of the ureter is 5-7 cm. It has a convoluted shape in the form of "knees". Only at the age of four the length grows to 15 cm. The intravesical part also gradually grows from 4-6 mm in infants to 10-13 mm by the age of 12.

In the pelvis, the ureter departs at an angle of 90 degrees, which is associated with the formation of the renal pelvis during the first year of the baby's life.

The muscle layer in the wall is poorly developed. Elasticity is reduced due to thin collagen fibers. However, the contraction mechanism provides a fairly large evacuation of urine, the rhythm of contractions is constantly frequent.

Congenital malformations are considered:

atresia - complete absence of a ureteral tube or outlet;
megaloureter - pronounced expansion of the diameter along the entire length;
ectopia - a disturbed location or attachment of the ureter, includes communication with the intestines, entry into the urethra, bypassing the bladder, connection with the internal and external genital organs.

Methods for studying the structure of the ureter

To identify pathology, methods are needed that reveal the characteristic picture of the lesion. To do this, apply:

finding out the history of the disease, complaints;
palpation of the abdomen;
x-ray examinations;
instrumental techniques.

Most often, the pathology of the ureters is accompanied by symptoms of pain. Typical for them:

character - constant aching or paroxysmal colic;
irradiation - to the lower back, lower abdomen, to the inguinal and external genitals, in children to the navel.

By distribution, one can judge the localization of the pathological process:

if the violations lie in the upper third of the ureter, then the pain goes to the iliac region (in the hypochondrium);
from the middle section to the groin;
from the lower third to the external genitalia.

The patient's complaints of cramps during urination and increased urge occur with pathology in the pelvic and intramural parts of the organ.

On palpation, an experienced doctor will determine muscle tension in the anterior abdominal wall along the ureter. For a more detailed palpation of the lower part, a bimanual approach (two-handed) is used. One hand is inserted with two fingers into the rectum, the vagina in women, the other makes counter movements.

In the laboratory, in the analysis of urine, many leukocytes and erythrocytes are found, which may indicate a lesion in the lower urinary tract.

Cystoscopy - By inserting a cystoscope through the urethra into the bladder, the openings (orifices) of the ureters can be viewed from the inside. The shape, localization, blood and pus discharge are important.

Using chromocystoscopy with a preliminary introduction of a dye into a vein, the rate of release from each hole is compared. Thus, one can suspect the presence of a one-sided blockage (stone, pus, tumor, blood clot).

Catheterization of the ureter is carried out with the thinnest catheter through the opening in the bladder to the level of detection of the obstacle. A similar approach with retrograde ureteropyelography allows you to check the X-ray anatomy of the ureters, the presence of patency of bottlenecks, tortuosity.

The plain urogram does not show the ureters, but in the case of an existing stone (shadow of calculi), its localization can be suspected.

The contours show physiological narrowing and the state of the segments between them, in this case, a violation of the passage of contrast was revealed up to complete obstruction of the lumen

The most indicative is excretory urography. A series of shots after intravenous administration contrast allows you to trace the course of the ureters and identify pathology. The shadow looks like a narrow ribbon with clear, smooth borders. The radiologist determines the location in relation to the vertebrae. In the pelvic cavity there are 2 bends: first to the side, then on the way to the center of the bladder.

Urotomography is performed when doubts arise about the significance of lesions from neighboring organs and tissues. Layered images allow you to separate them from the ureter.

Motor skills are studied using urokimography. The method allows you to identify decreased or increased muscle tone of the wall. Modern devices make it possible to see the contraction of different parts of the ureter on the screen, to study the electrical activity of cells.

Knowledge of the structure and location of the ureters is necessary for the diagnosis of diseases of the urinary system, comparative pathology, accompanied by urinary retention. Each surgical intervention in operative urology needs anatomical, age characteristics, approach of neurovascular bundles. In medical language, they are called topography.

The ureter in women is a paired tubular organ located retroperitoneally, it communicates the renal pelvis with the underlying bladder. Ureter length at adult woman ranges from twenty nine to thirty five centimeters. The diameter of the ureter changes throughout its entire length, in the area of \u200b\u200bits anatomical constrictions, namely at the point of exit from the kidney, when passing through the muscular diaphragm of the small pelvis, when directly entering through the bladder, it is several millimeters, in other places the lumen of the ureter can reach one centimeter , its width may vary.

What parts of the ureter can be distinguished? They are distinguished by two:

The abdominal part departs from the pelvis, begins with a bend, then goes downward, lying on the front surface of the lower back muscle, reaches the pelvic line.
The pelvic part. In which the ureter is located retroperitoneally, it goes down. At the bottom of the bladder, it penetrates into it, from the inside it looks like a gap.

Layers of the walls of the ureter

Internal longitudinal;
Medium circular;
Outer longitudinal.

The last layer has separate bundles, their increase is observed at the bottom of the organ.

The mucous membrane has longitudinal folds; from the inside, the organ resembles a stellate structure. In the depths lie the tubular-alveolar glands.

The topography of the ureters differs significantly on the right and left sides. The position of the ureter on the right at the beginning is located behind the intestine. The distal part of the urinary tube crosses the base of the iliac suspension apparatus small intestine... At the transition to the intramural ureter, the iliac arteries are in front.

On the left side, the urinary tube can be located behind the bowel bend, in the small pelvis there is a cross between the vessels. The ureter in men along its length makes a cross with the testicular artery, and in women with the ovarian artery.

Inside the pelvis, the topography is the same on both sides, but differs depending on the gender.

In men, before entering the bladder, the vas deferens is attached, which runs along the inner side.

In women, the urinary tube penetrates the peri-uterine tissue.

The anatomy and structure of the ureters are the same in both sexes.

Bookmarking an organ in intrauterine development

The development of the urinary tube occurs during pregnancy. Moreover, these organs are able to stretch due to the fact that they have longitudinal folds in the mucous membrane. Under the mucous membrane, the glands are located in structure similar to the prostate. The ureters of a newborn can develop long after birth. The ureter develops throughout pregnancy.

To see where the ureter originates, how it can be located, it is necessary to take a purchased anatomy textbook, where there are visual drawings.

Bladder

It is an organ located in the pelvis behind the pubic symphysis. It fills with urine that flows through the orifice of the ureter, so it changes in size. When full, it resembles a pear in its appearance. An empty bubble looks like a saucer. It can hold up to eight hundred milliliters of urine. Overflow should not be allowed during pregnancy. Since during pregnancy there is pressure on him by the uterus.

The functions of the ureters and bladder are reduced to transport, reservoir and excretory.

Developmental anomalies

The most common option is when 2 urinary tubes leave the left kidney. There may be two outlets in the bubble, or one. Recovery is carried out in an operative way. Sometimes you can observe a doubling of the left kidney when there are 2 of them.

Renal colic may occur during pregnancy. In this case, the middle third of the ureter, or the ureteral valve, suffers. To determine soreness on the body there are certain points of palpation, there are 2 of them. The first points are determined on the outer surface of the rectus abdominis muscles at the level of the navel from 2 sides. The second, lower ones are located along the same muscles, but the ridges of the iliac bones of the pelvis serve as a reference point. During pregnancy, these landmarks may be uninformative due to the displacement of the urinary tubes by the pregnant uterus and the fetus. If the ureter is obturated with a stone, then its size sharply increases in the distal part, it is overstretched, which causes intense paroxysmal pain. It can radiate to the groin, external genitals. At the same time, the patient cannot find a comfortable position for herself. The pain is not relieved by taking non-narcotic analgesics. It is imperative to seek the advice of a specialist. Only he can prescribe the appropriate therapy that will help solve this problem and will not harm the fetus and its intrauterine development.

What is a ureteral valve and why does it occur?

A ureteral valve is a blockage along the tube that prevents urine from flowing normally. These structures develop in the womb, function until a certain time, and then disappear without a trace. Sometimes they can remain, causing acute urinary retention over time.

Symptoms

Due to the overstretching of the renal capsule, an intense pain syndrome occurs. At the initial stage, these pains are constant, but bearable. Complete obturation mimics all symptoms that resemble renal colic. If you do not take urgent measures, then stagnant urine provokes the formation of stones. If such complaints arise, you should immediately contact a specialist.

Diagnosis of this pathology is carried out on the basis of excretory urography. This method allows you to see the ability of the kidneys to excrete using a contrast agent.

Treatment of this pathology is performed using a cystoscope, which allows you to restore the patency of the urinary tube. If this method fails, then resort to surgical treatment... In this case, the urinary tube is opened, the valve is removed, and the surgical wound is sutured in layers. If it is not possible to carry out the operation, then they resort to puncture of the pelvis. Under the control of an ultrasound machine, a catheter is inserted into the pelvis, thus carrying out the outflow of urine.

If the pathology is detected in time, to prevent urosepsis, to carry out treatment, then this pathology can be cured. The prognosis for recovery is always good.

People who often have a problem with the urinary system are very interested in many questions about this disease. There are many aspects, since the features of pathological processes are diverse, as are the variants of the form of the disease and the stage of development. It all depends on the structure of the ureteral organ, and their immediate functional norms.

Function of the ureters and bladder: Many people wonder how this organ and the bladder work, their functional abilities, size and location. Bladder is called the organ where urine is accumulated and temporarily stored, which at regular intervals must leave through the urinary canal. The main role is that it is stored and secreted into the urethra. In shape and position in the body, it is located depending on how much it is filled with urine and what gender the patient has.

The ureter in women: in the female, it is located in such a way that when the bladder is empty, it is located in the cavities where the pelvis is. And the rectum is separated from it by the vagina and uterus. When it is full and there is urine in it, then its shape changes, if it is very full, then it stretches and reaches the area where the navel is. How is it located in the male? With an empty bladder, it is located where the cavity is in the small pelvis, the rectum separates its seminal vesicles and areas where the vas deferens. Moreover, in the lower part, it is fused with the prostate gland, and in the upper part there is always mobility.

The upper surface is adjacent to a loop in the intestine. How is it located in a newborn baby? The ureter is located slightly differently in newborns. The ureters of the newborn have many differences, the ureter does not originate from that of adults. First, the location of the bladder in newborns is much higher than in adults. From the first days of a child's life, he goes down every day, and already when the child is half a year old, he reaches the level of the upper edges of the fused pubic bones. Possesses distinctive features his internal structure and blood supply. The bladder has three layers:

muscular;
slimy;
serous.

There are three types of fiber in the muscle layer, which have the ability to stretch and contract. This usually occurs where the bladder transitions to the urinary canal. In this case, a sphincter of its own kind is formed in the muscle layer, in which the contraction function is developed, and involuntary. It is independent of a person, characterized by a mucous membrane, which is pink in color, it has folds on it.

Also on the membrane there is the formation of small mucous glands and lymphatic follicles. The blood supply to this organ occurs through the upper and lower cystic arteries. These arteries originate from the basin of the large iliac artery. In the lymph, all the inguinal lymph nodes that are located nearby swell. There are 2 points - the lumen of the ureter and the diameter of the ureter. The position of the ureter depends on the stage of development of this process.

Functional actions

Like every organ, this one also has the structure of the ureters. Parts of the ureter: intramural ureter, middle third of the ureter, ureteral valve, ureteral orifice, ureteral vein. When the ureter develops, the width and length of the ureter depends on the structural features of the body. The ureter in men has some differences (there are 2 points). Sometimes abnormal processes occur (formation or development of the disease). These are diverticula, as they call it, when the wall protrudes, and a bag-like appearance is formed. It comes in single and multiple versions.

Stagnation of urine occurs in the diverticulum, resulting in a disease such as cystitis. Another type is when a fistula is in the ducts, it is responsible for connecting the bladder through the umbilical cord with the amniotic fluid when intrauterine development occurs. It is very rare if it is absent or underdeveloped. These flogging are incompatible with the vital activity of the body. The organ originates from the pelvis, which is on the kidney. It is a kind of hollow tube, with a diameter of about six millimeters and a length of three hundred millimeters.

One of the tasks is the delivery of urine from the kidneys to the bladder, and, accordingly, preventing the return flow of urine. When the ureteral valve is affected, the topography of the ureter is necessary (if necessary, it is done 2 times). In the wall of organs there are three layers - connective tissue, muscle and mucous. In the urinary system human body the composition includes certain organs that are responsible for ensuring that tasks and functions are performed, and, moreover, each of these organs has its own function or task (it is especially important that everything functions correctly, and there are no failures during pregnancy).

Together, they form a whole system of work. But if at least one organ is disturbed and it ceases to function, then a disease of the entire urinary system develops, and as a result, multiple unpleasant symptoms and discomfort are formed (this is dangerous during pregnancy). The pathological process in the organ is quite rare. By its nature, it can be congenital, inflammatory, neoplastic or traumatic (due to various injuries). The disease of the organ and the symptoms of this ailment always manifest themselves in different ways, it all depends on what factors caused the disease (often, this is when the ureteral valve is broken, it is dangerous during pregnancy).

Symptoms of functional dysfunction

If there was a defeat in the organ, then clinical picture will manifest itself as paincoming from the lumbar region or the stomach will hurt on the side where the diseased organ is located. If irritation has formed in the lower part of the tube, then the symptoms will be manifested by frequent urination. The formation of hematuria will occur (2 times), if a violation has formed, which affects the outflow of urine from the kidneys, then the symptoms will manifest themselves as spontaneous manifestations renal colic... At the same time, the secreted diuresis will decrease or there will be no urine at all.

It is also possible to observe nausea and vomiting, as well as increased blood pressure... The most common disorders in the ureters are abnormal processes, they are formed due to the kidney or its own defect. These deviations are a quantitative indicator that causes non-compliance with the norms. This can be in congenital malposition of structures and shapes in the ureter, during pregnancy. Perhaps due to the fact that the stone is stuck in the organ, with the structure, this is when it narrowed, and the processes responsible for the outflow of urine were disrupted.

There are 2 cases when a patient, after various diagnostics, the doctor observes reflux of a vesicoureteral nature. The type of this disease can be located and develop in the organ itself. Characterized by the fact that there was an underdevelopment in the lower muscular valve, or because of some reason the organ relaxed. In this case, urine may be drawn from the bladder. Due to serious pathological processes that interfere with work in genitourinary system... Sometimes the development of a disease such as Ormond is formed (purchased process). When it forms in the ureters, a process of complete failure or constant squeezing of tissues can occur. This disease often manifests itself in men.

Consequences of organ failure

Megaureter formation when the system may not draw urine. This is a type of disease when neuromuscular dysplasia occurs in an organ. Is an congenital malformation, and a characteristic structural change that gradually reaches the kidneys. Two types of progression are the ureterocoela, when a hernia-like defect is formed, in the places where the connection to the bladder goes, in the intervals from the kidneys to the bladder, where a tumor sometimes forms. In patients with tuberculosis of the kidneys, one must be careful so that the disease does not spread to the ureter, since they are interrelated and the degree of progression of the disease is very high.

With epiema, a stump is a pathological process when purulent accumulations form, they appear due to an already existing ailment in one of the urinary structures. During pregnancy and the first symptoms of an unhealthy sign of the body, it is necessary to consult a specialist in a timely manner for help in medical institution this specialization. If the order of the genitourinary system or problems in the ureters has occurred, medical attention is also needed.

Symptoms of pain in the ureters in both women and men indicate that a disease has occurred in the urethra. It manifests itself in an independent way or due to the aggravated action of pathological processes in any part of the urogenital structures.

The restoration of the left kidney or the right one is carried out, as this may be one of the reasons. The attending physician establishes this after a thorough diagnosis. The most important function of the ureters is to promptly remove the urine formation in the kidneys into the bladder. As a rule, first, the upper section in the ureter is filled, due to the contractions of the muscle fibers in the walls, urine begins to move and enters the bladder, even if the person's position is horizontal. Various examinations are performed in the ureters when the patient talks about complaints (ultrasound of the right and left kidney). As a rule, one of the complaints is persistent pain syndrome.

In this case, the pain can be stabbing, aching and paroxysmal, radiating to the stomach. When palpation is performed, the anterior wall may be strained on the abdomen, and pain will occur along the course of the ureters. After collecting tests, if a pathological process has formed in the ureter, then the presence of leukocytes and erythrocytes will be found in it. As a result, there will be an accurate diagnosis that inflammatory changes in the ureter have formed. The anatomy of human organs is very interesting, and, as a rule, each organism has its own characteristics. Therefore, at the first sign of symptoms, specialist advice is necessary.

The passage of urine through the ureter is carried out by contractions of the segments of the ureter - cystoids, of which there are usually three.

Ureter (ureter) ... The ureter is a flattened tube 27-30 cm long. From the renal pelvis, the ureter goes down and medially, to the unnamed pelvic line, which divides the ureter into two anatomical and surgical divisions: the upper - abdominal and lower - pelvic. Abdominal the ureter is located along the inner edge of m. psoatis and loosely welded to the parietal peritoneum, which should be remembered when looking for the ureter in this area. The spermatic vein, which passes here lateral to the ureter and crosses it at the entrance to the pelvis, is of identification value. In the pelvic region, the ureter forms an arch with a bulge facing the lateral side, heading down and medially to the bladder. The ureter flows into bottom wall the urinary bladder obliquely, piercing it from the side of the midline, and opens on the mucous membrane of the bladder with a slit-like opening at the upper corner of the cystic triangle.

At the lin level. innominata of the pelvis, the ureter crosses the iliac vessels, after which it is located medial to them. The peri-vesicular segment of the ureter crosses the obturator artery and vein and the external umbilical artery, as well as the vas deferens in men and uterine artery among women.

The wall of the ureters is formed by two layers of smooth muscles: internal - longitudinal and external - circular. In the bladder wall, the ureter is surrounded by a third muscle layer, the so-called Waldeyer's ureteral sheath, which is functionally connected with the muscles of the bladder. The mucous membrane of the ureter is covered with stratified transitional epithelium.

The lumen of the ureter is on average 5-8 mm. At the exit from the pelvis, at the intersection of the iliac vessels and in the thickness of the bladder wall, the lumen of the ureter is narrowed to 3-4 mm.

The arteries of the upper part of the ureter depart from the renal arteries, the middle - from the seminal and iliac arteries, the lower - from the vesical or uterine. The veins correspond to the arteries.

The lymphatic vessels of the upper section flow into the glands of the renal hilus, the middle - into the retroperitoneal, and the lower - into the iliac lymph nodes.

The ureter is innervated from the renal, seminal and iliac plexuses.

Of anomalies of the ureter most often there is a doubling of the ureter, which can be complete - two ureters depart from and in the bladder they open on one side with two mouths - or partial, when the ureter is not doubled all the way and opens in the bladder with one mouth. Doubling of the ureter is often accompanied by a doubling of the kidney.

Congenital atony of the ureter is a functional concept, determined by the state of its dynamics. The ureter is dilated, while its walls are thinned. Atony is accompanied by a delay in the passage of urine through the ureter. The atonic ureter is called a megaloureter.

Often there is an abnormal narrowing of the bladder opening of the ureter and a spherical protrusion of its mouth - ureterocele, which is unilateral or bilateral. Other ureteral abnormalities are rare.

Diagnosis of anomalies of the ureter is made using (see), retrograde (see) and excretory (see).

Treatment of anomalies of the ureter - operative, with ureterocele - endovesical orifice of the ureter.

Injury to the ureter closed ones arise due to sudden compression of the trunk, a blow with a blunt object or a fall from a height and lead to a complete or incomplete rupture of the ureter.

Signs of damage to the ureter - pain in the lumbar region, blood in the urine, after a few days heat and swelling in the lumbar region due to urinary flow (see). With a closed injury of the ureter, drainage of urinary flow and nephrostomy are performed; subsequently - reconstructive surgery on the ureter.

Open injuries of the ureter are more common in wartime. Signs are blood in the urine and urine output. If ureteral damage is suspected, excretory urography and retrograde ureterography are performed. Treatment is prompt, as with a closed injury.

Sometimes damage to the ureter occurs during gynecological or obstetric operations. If damage to the ureter during surgery is established, it is necessary to immediately restore the patency of the ureter. With unrecognized damage to the ureter, a ureteral or narrowing of the ureter is formed.