Ureteral stenosis includes congenital ureteropelvic junction stenosis, inflammation and stenosis after surgical injury. In recent years, the extensive operation of ureteroscope is also easy to cause ureteral injury, especially ureteral orifice stenosis. The more complete the stenosis is, the closer it is to the kidney, and the earlier and more serious the damage to the kidney appears. It will eventually lead to the loss of renal function.
Clinical manifestations 1. The affected side has low back pain, sometimes touching the kidney with hydronephrosis.
2. There are chills, fever or pyuria when complicated with infection.
3. Uremic manifestations may appear in bilateral ureteral stricture.
The diagnosis is based on 1. History of pelvic or ureteral surgery.
2. Low back pain, cystic mass in the upper abdomen.
3.b-ultrasound: Ureteral dilatation and hydronephrosis above the stenosis.
4. Isotopic renogram is obstructive renogram.
5. Intravenous pyelography (IVP) showed the degree and stenosis of hydronephrosis.
6. Diagnosis can be made by retrograde ureterography.
Handling principle: 1. The ureteropelvic junction stenosis can be treated by cold knife percutaneous nephrolithotomy, balloon dilatation and stent implantation, or open plastic surgery.
2. Ureteral stricture is short, and ureter can be dilated by inserting ureterectatic catheter through the stricture under the direct vision of ureteroscope.
3. If the lower ureter is narrow, the stricture can be removed and bladder replantation or bladder wall flap ureteroplasty can be performed.
4. The middle and upper ureter is narrow, and the lumen expansion fails. Stenosis can be resected and anastomosed end to end. It is feasible to replace ureter with intestine after resection of long ureteral stricture.
5. After the ureter is formed or anastomosed by operation, the 8FDJ tube should be placed and kept for 4-6 weeks.
5 medication principle 1. First use "A" drugs to prevent infection.
2. There is infection. In order to control infection, drugs in item "B" or "C" can be used.
3. Generally, intramuscular injection or intravenous administration is selected. In order to protect renal function from damage, drugs with high nephrotoxicity are prohibited or used with caution.
6. Auxiliary examination 1. In general, the inspection frame is "A".
2. If the diagnosis is complicated or unclear, check items in check boxes "b" and "c" can be added.
7 efficacy evaluation 1. Cure: Ureteral stricture was relieved, renal infection was controlled, and intrarenal pressure returned to normal (within 10cm water column).
2. Improvement: The ureter is still not unobstructed after operation, and the intrarenal pressure is > > 15cm water column.