Causes of obstructive uropathy in children, inflammatory and neurogenic disorders of urine outflow

Abstract

Megaureter is one of the most common pathologies of the upper urinary tract, which is dangerous in childhood due to possible complications such as chronic urinary tract infections with the outcome of chronic kidney disease. Currently, the international classification based on the totality of excretory urography, voiding cystography, urethrocystoscopy and urodynamics data, which includes 4 groups of megaureters: reflux, obstructive, non-reflux and non-obstructive, as well as vesicular megaureter, has received the greatest relevance for the differentiation of megaureter. Clinically, this pathology can occur in 2 periods — aseptic and infectious. The doctor should be alerted to complaints of abdominal pain unrelated to eating and defecation, abdominal asymmetry, episodes of fever, profuse sweating, a history of recurrent urinary tract infections, and lag in physical development. A number of standard and special laboratory and instrumental studies are used to diagnose the megaureter. The introduction of antenatal ultrasound diagnostics of the urinary system organs into practice has increased the chance of detecting a megaureter in the prenatal period. Treatment of a megaureter depends on its cause and the degree of enlargement and tortuosity of the ureter. Both operative and conservative methods of megaureter correction are used. If conservative tactics are futile, endoscopic correction of the ureteral orifice, dissection of the orifice, ureteral stenting, and balloon dilation are used, depending on the cause. In the absence of the effect of these methods, neoimplantation of the ureter into the bladder is used. Conservative treatment includes drug therapy and physiotherapy methods of treatment in conjunction with physical therapy. In case of an existing urinary tract infection, it is advisable to prescribe antibacterial therapy.