PERIURETERITIS (periureteritis; grech, peri around, near + ureter an ureter + - itis) — an inflammation of an extima of an ureter and periureteral cellulose.
For the first time the message on P. was made by I. Aljbarran in 1905 P. — almost always a secondary disease. Are its most frequent reason inf. processes in uric ways, paracystitis, a paranephritis, an ileitis, and also distribution of an inflammation after operations with opening of the uric ways which are followed by an uric zatek in periureteral cellulose. Seldom P. arises in the hematogenous way from suppurative focuses in other areas. Sometimes P. develops after repeated operations at the persons predisposed to development of hyperplastic processes. At stones of ureters, it is long being in one place, in 2/3 cases there is an accompanying local Item. At pyelonephritis P. in upper parts of an ureter is almost always observed.
The item can be segmented and diffusion. At segmented P. cellulose of one or both ureters is struck on the limited site, at diffusion — throughout. The ureter at the same time is deformed, its gleam is narrowed, broken outflow of urine from a kidney with the subsequent megaloureter above the place of narrowing and a renal pelvis with emergence of a gidroureteronefroz (see. Ureter ) and pyelonephritis (see).
A clinical picture
Usual a wedge, P.'s manifestations — dull aches in lumbar area, times nausea, vomiting, are possible attacks of renal colic owing to disturbance of outflow of urine. The hyposthenuria, a proteinuria, a leukocyturia are noted. In rare instances at P.'s development any the wedge, manifestations are absent. If P. proceeds hard, with formation of suppurative focuses, then pains in lumbar area amplify, temperature increases, there are oznoba, acceleration of ROE is noted. At bilateral damage and drift of a disease against the background of the alternating disturbance of outflow of urine there are signs renal failure (see).
the Diagnosis on the basis of complaints it is difficult to make the diagnosis since the expressed P.'s phenomena at insignificant subjective manifestations are quite often observed and, on the contrary, variety of complaints at minor changes in uric ways. At expansion of pyelocaliceal system by a palpation the kidney increased in sizes is defined. Sometimes at a deep palpation it is possible to probe a reinforced ureter in the form of the dense roller or infiltrate on the course of an ureter. In a small basin it can be defined at a research by a rectum or a vagina.
An important role in diagnosis is played by X-ray contrast methods of a research. By means of excretory urography (see) reveal increase in the sizes of kidneys, expansion of renal cups and a pelvis, dilatation) an ureter proksimalny zones of its defeat. The excretory polipo-zitsionny piyeloskopiya and an urorentgenokinematografiya is more informative (see. X-ray cinematography ), at which it is possible to define disturbance of sokratitelny ability of an ureter proksimalny the changed site, the extent of a zone of defeat, and also funkts, a condition of an ureter distalny zones of defeat. At bad contrasting of kidneys and ureters apply a retrograde (fig.) ureteropiyelografiya (see. Piyelografiya ) and urokinematografiya.
Treatment is directed to elimination of the basic process which caused the Item. At moderately expressed a wedge, and rentgenol, manifestations apply physiotherapeutic procedures, antibiotics, resorptional means (an aloe, a lidaz, a vitreous, pyrogenal). For the prevention of a recurrence appoint corticosteroids (a cortisone, hydrocortisones) which are slowing down growth of granulyatsionny fabric and development of hems. At the permanent narrowing of an ureter which is not giving in to conservative treatment undertake an operative measure. If the wall of an ureter is not involved in infiltrate or hems, its release from a prelum — an ureterolysis is possible. In the presence of fibrous changes on a big extent of an ureter make its moving to an abdominal cavity. In case of P. on small extent with involvement in process of a wall of an ureter the resection of the changed site with the subsequent anastomosis the end in the end is possible (see. Ureter, operations ). The item with defeat of an ureter in the lower third on a considerable extent can demand substitution of an ureter the rag of a bladder created in the form of a tube (see. Boari operation ). Defect of an ureter of big extent in a pelvic part can be replaced on Demel's way (see. Ureterocystoneostomy ). At defeat of an upper and average third of an ureter make substitution by its segment of a small bowel (see. Intestinal plastics , Uretero of plastic ).
The forecast and Prevention
the Forecast after timely executed organ-preserving operation favorable.
Prevention consists in timely treatment of inflammatory diseases of kidneys and uric ways, intestines, genitalias and other abdominal organs and retroperitoneal space, and also the focal purulent processes of any other localization promoting P.'s emergence and supporting its current.
Bibliography: Derevyanko I. M. Obstruction of ureters, Stavropol, 1979; To and D. V N. Damages of an ureter to obstetric and gynecologic practice, M., 1967; And 1 b and of of a n J. Exploration des fonctions renales, P., 1905; K i with k h a m of Page J. E. ampere-second of o 1 p o y s F. L. Periureteral fascitis (periureteritis), J. Amer. med. Ass., v. 171, p. 2202, 1959.
K. H. Korayev.