What Is Ureteral Reimplantation?
The double ureter is also called a double ureter, a repeated renal ureter. It refers to a congenital malformation of the kidney in which the affected kidney is a combination of two parts of kidney tissue with a common envelope, but the pelvis, ureter, and blood vessels are separated. Women are more common.
- nickname
- Double ureter, repeated renal ureter
- Visiting department
- Urology
- Multiple groups
- female
- Common causes
- Embryonic abnormalities, caused by autosomal dominant inheritance
- Common symptoms
- Constipation, pain behind the pubic bone, ejaculation discomfort
Basic Information
Causes of double ureter
- Embryogenesis
- At the 4th week of the embryo, the ureteric buds grew rapidly, the ureter formed at the proximal end, and the distal end was covered by the original renal tissue mass, and developed into the renal pelvis, calamity and collecting duct. If the distal branch of the ureter has more than two branches, a repeated renal pelvis is formed; if the branch is too early, an incomplete double ureter is formed, and the ureter is Y-shaped. In addition, if another ureteral bud (or vice ureteral bud) develops at the lower end of the mesonephric duct, which rises side by side with the normal ureteral bud, a complete double ureteral deformity occurs.
- 2. Genetics
- The double ureter may be autosomal dominant, with incomplete penetrance. Environmental factors affect the occurrence of double ureters.
Double ureter pathogenesis
- According to the positional relationship of repeated ureters, it can be divided into 3 types:
- Incomplete double ureter
- The ureters of the upper and lower kidneys are fused into a ureter in a "Y" shape and open in the normal position in the bladder. The meeting point can be anywhere in the ureter.
- 2. Complete double ureter
- The two ureters are completely separated, draining the urine of the upper and lower kidneys, respectively, and opening in the triangle of the bladder at the same time. Generally, the lower ureter's ureter opens in a normal position in the bladder, and the upper kidney's ureter crosses the lower kidney's ureter before entering the bladder.
- 3. Complete double ureter with ectopic opening of superior renal ureter
- That is, a complete double ureter opens the middle and lower kidney ureter in the bladder, and the upper kidney ureter opens in a place outside the bladder. Males usually open their mouths in the posterior urethra, seminal vesicles, and vas deferens, while females can open their mouths in the urethra, vagina, vulvar vestibule, and cervix.
Clinical manifestations of double ureter
- Clinical symptoms vary greatly with gender, and some cases have no obvious symptoms. Generally the symptoms of urinary tract infections. Such as constipation, postpubic pain, ejaculation discomfort, etc., can also be accompanied by urgency, frequent urination, occasionally infertility treatment but rare incontinence. For women, the most common opening is the vestibule, which can also be located in the upper vagina, uterus, and ovaries. Because the ectopic opening is mostly located at the distal end of the external urethral sphincter, it usually manifests as persistent urinary incontinence after normal urination. Another feature of ectopic ureteral openings in women is persistent vaginal discharge. Most female patients are complicated by acute and chronic urinary tract infections. A few patients present with hydronephrosis of the pelvis and ureter, and occasionally see patients with abdominal masses.
Double ureter diagnosis
- The diagnosis mainly depends on intravenous urography and cystoscopy. If two or more ureteral openings are found during cystoscopy, the diagnosis of double ureteral malformations can be established. If the ureteral catheter can be inserted for retrograde angiography, the diagnosis will be clearer.
Double ureteral treatment
- Patients who do not have symptoms such as urinary tract infection, obstruction or drip urinary incontinence, and who have no serious complications such as ureteral effusion, reflux, and stones, need no treatment. Generally, the principles of surgical treatment include the following three points:
- Incomplete double ureter
- Upper renal function is present with uretero-ureteral reflux.
- (1) The double ureter confluence point is at the upper third, and a longitudinal ureteral side-to-side anastomosis is performed.
- (2) The ureteral bladder replantation of the upper renal segment is performed at the lower 1/3 junction of the double ureter.
- 2. Complete double ureter
- Those with upper renal segment function and bladder-ureteral reflux are treated with ureteral bladder replantation and anti-reflux surgery.
- 3. Partial nephrectomy
- If the urinary tract infection can not be controlled, or a little drip urinary incontinence (with ectopic opening), or the upper renal segment function has been basically lost, you can do partial upper renal segment resection. The ureter is cut near the confluence point (incomplete double ureter) or at the lowest level, and a total ureterectomy (complete double ureter) can also be performed.