Ureteral cysts are caused by narrowing of the ureteral opening, weakness of the muscular layer of the ureteral segment into the bladder and poor urine elimination, resulting in gradual enlargement of the submucosal segment of the ureter and protrusion into the bladder to form cysts. The disease is more common in girls, about 3~4 times more common than boys, and there is no obvious difference between the left and right sides, and it can develop at any age, but it is more common in 3~7 years old. 80% of cysts come from heavy kidneys.
Pathology】Ureteral cysts have thin walls, the outer layer is bladder mucosa and the inner layer is ureteral mucosa with connective tissue in between and lack of muscle structure. According to the location of the opening, it can be divided into simple type (in situ type) and ectopic type. The former mostly originates from a single ureter, with a small bulge, located in the normal ureteral opening in the bladder or slightly outside, and is more common in adults; the latter is often combined with double ureteral malformation of the duplicated kidney, mainly in children, mostly in girls. The ureteral bulge from the upper kidney varies in size from 1 to 50 px in diameter to almost the entire bladder, and can be located in the bladder neck or posterior urethra, often causing lower urinary tract obstruction, and is a common cause of urinary tract infection in girls.
【Diagnosis
(A) Clinical manifestations
1, difficulty in urination The bulge blocks the internal orifice of the urethra, causing difficulty in urination, frequent urination, urgency, forceful urination and crying.
2, urinary tract infection Due to incomplete urination complicated by urinary tract infection, fever, pus urine, hematuria.
3.Foreign body outside the urethra Girls often have purple-red masses coming out of the urethra after urination.
4.Urinary incontinence Large bulge can make the girl’s external sphincter relaxed and incomplete incontinence occurs, often wet pants.
(II) Examination
1, local examination Careful examination of the girl’s vulva, such as prolapse, should exclude the block from the vaginal orifice, ureteral bulge is mostly red spherical, the surface has tiny blood vessels, such as embedded, block edema, congestion, erosion, bleeding, can not be retracted.
2, intravenous urography Simple type shows good kidney morphology and function, with round filling defects in the bladder; ectopic type shows double ureteral malformations on one or both sides of the kidney, with more kidney and ureteral dilatation on the affected side, water retention or no shadowing.
3, urinary cystourethrography Low-concentration contrast agent slowly injected into the bladder can be seen in the bladder round or oval filling defect shadow, can be compressed during urination, some cases can be accompanied by vesicoureteral reflux.
4. B-type ultrasonography can detect bulging masses in the bladder, lateral or bilateral duplicated kidneys, double ureteral malformations and hydrocele.
5, Cystoscopy can observe a round bulge near the triangle with inflammatory reaction of the bladder membrane or see a rhythmic filling and atrophy of the bulge. If the bulge is large, cystoscopy is difficult to enter, and only a thin cystic wall with vascular distribution can be observed.
【Treatment
(a) simple ureteral bulging cysts are small and asymptomatic, no need for surgical treatment, the emergence of symptoms for bulge removal ten ureteral reimplantation or endoscopic transverse cyst dissection, observation and follow-up
(B) ectopic ureteral dilatation
1, the upper kidney function is good, the ureter is not dilated for bulging resection ten ureteral reimplantation, or endoscopic cyst incision, observation and follow-up.
2, upper kidney dysplasia, poor function, ureteral dilatation for heavy nephrectomy and ureteral resection, if the obstruction symptoms do not relieve, and then for bulging resection.
3, bilateral duplicated kidney with double ureteral expansion if both upper kidney function is poor, perform double kidney ureteral resection in stages.
Prognosis
1. If the endoscopic cyst excision is not effective or reflux occurs, elective resection + ureteral reimplantation should be performed.
2. For ureteral reimplantation, ultrasound examination should be performed 1-2 months later to understand the expansion of kidney and ureter, and urinary cystourethrography should be performed 3 months later to understand whether there is reflux.
3. For those who underwent ureterectomy, ultrasonography or cystogram should be performed 3 months after surgery to understand the dilatation and atrophy of the kidney and decide whether to remove it.