Treating kidney and ureter stonesBy flexible and laser endoscopy and primary prevention
Excessive food intake and high temperatures in the atmosphere are the two main reasons for the high incidence of this kidney disease. The incidence of kidney stones and ureter occupies the third position of urinary tract diseases, urinary tract infections first place in both sexes of humans, and enlarged prostate and its cancer second in men.
The incidence of these stones during the life span is now estimated at 5-10%. Kidney stone infection. The infection is three times as much for a woman. The second infection rate for stones after treatment of the first injury is 10% after a year and 50% within ten years.
The peak of infection is at the age of thirty for a man and their weakness for a woman is one at the age of thirty-five and the other at the age of fifty-five.
The formation of stones in humans has a relationship with the race and the human race, the geographical location of living (hot areas) and the change of seasons during the year, especially in the summer.
According to recent global health statistics, more than 40-50% of kidney and ureter stone patients are receiving treatment with external electromagnetic waves (ESWL) and 50-60% endoscopically by laser, as clinical results in recent years have confirmed the success of these two non-surgical treatments. The remaining 10% of these patients need renal endoscopy for other pathological reasons, especially in the case of very large coral kidney stones.
Ureteral reflux and treatment
Kidney diseases in children as a result of urinary bladder ureteral reflux, which is the return of urine from the bladder to the ureter or to the kidney for various reasons, the most important of which is the presence of a birth defect in which the child is born, and the second reason is the weakness of the ureteral muscle when it meets the bladder and the third reason is the large opening of the ureter in the bladder, and sometimes Others The urine pressure in the bladder is high due to the presence of a near blockage in the neck of the bladder due to the urethral posterior valve, or the urethra, and thus the urine returns to the ureter – usually these children suffer from the problem of urinary reflux during the first five years of life and the child may have it after birth MB This disease is one of the causes that lead to chronic kidney failure, which develops to advanced renal insufficiency in children as well as in adults of adulthood, and it leads by 20% to high blood pressure in these children as well as in adults of adulthood, as the pathogen for kidney disease Reflux Nephropathy is the ureteral and renal cystic reflux of urine contaminated with germs, where inflammation occurs in the affected area of the kidneys, and as a result of this, kidney scars arise and these lead to impairment of renal function as a result, and the incidence of this urinary reflux is spread among three girls among all Thousand i I was born and one in every thousand children.
- A) Pathological factors: In addition to the reasons mentioned in the introduction, the pathogen that may be responsible for the occurrence of urinary return from the bladder to the ureter or to the renal pelvis is bacterial urinary infection and inflammation of the bladder, which in turn leads to scarring of the bladder as well and sometimes stiffness In the port of the ureter in the muscular part of the bladder, which is originally responsible for the mechanism of closing the ureteral port in the bladder, as this stiffness in this part of the ureter affects the susceptibility to closure and causes urinary regurgitation to the ureter or kidney.
- B) Congenital factors:
- The movable ureter opening.
- An imbalance in the formation and emergence of the Trigone.
- Decrease in the inclination or length of the ureteroformular segment.
- Neurological diseases of the bladder or lower part of the ureter.
- C) Factors as a result of secondary pathological changes:
- Narrowing in the bladder neck.
- Stiffness in the cystic neck.
- Median bars.
- Posterior Urethral Valve.
- Scarring narrowing of the urethra as a result of surgical complications such as a partial wound of the ureteral ureter or a wound in the nozzle of the ureter after the process of extraction of the congenital ureterial cyst.
- D) pathological regression stages:
There are five reactionary stages that have a sick effect on the bladder, ureter, and kidney:
The first stage: In this stage, the urethral reflux reaches the ureter only and does not extend to the renal pelvis, and there are sometimes slight expansions of the ureter.
2- The second stage: In this stage, the ureteral and ureteral reflux have reached the renal pelvis and are without expansion in the renal pelvis or in the whole system of the college, and the kidney vesicles are also normal.
3- The third stage: In this stage, the urethral, ureteral and renal reflux is accompanied by a slight or moderate ureteral expansion, and there may be curves in the ureter, and at the same time there are medium-degree expansions in the renal inclusive system, but the renal vesicles may be distorted by this Urinary flashback.
4- The fourth stage: In this stage, the urethral, ureteral and renal reflux has led to an expansion of the average degree in the ureter with milky curves, and at the same time there are medium-degree expansions within the renal system of the renal pelvis, while the renal vesicles are not sharp but Renal papillae are visible.
5- The fifth stage: In this advanced stage of urinary and urinary bladder reflux, there is a large expansion of the ureter with curves in it, and the expansion of the renal pelvis and its combined system in the kidney are very noticeable, but renal papillae appear naturally, and in this advanced stage there is a flashback Poly inside the kidney tissue itself.
The symptoms of this problem in the child are a rise in body temperature with a fever, burning in the urine, stomach cramps, or involuntary urination of the child. In these cases, the mother is advised to present her child to the doctor who specializes in treating urinary diseases and surgery in children to perform the necessary checks To exclude kidney damage or scarring and set an appropriate treatment strategy.
Before starting any treatment for this disease, whether it is traditional surgical or modern endoscopic or non-surgical, the diagnosis of the defect or the cause of reflux and the stage of urinary reflux must be complete:
- Imaging of the kidneys, ureter and bladder by ultrasound and color doppler.
- Kidney and ureter x-ray imaging.
- Laparoscopic examination of the bladder and urethra.
- Posterior imaging of the ureter by color X-ray, and through this examination we can diagnose the retrograde stage.
- URO DYNAMIC.
- Colored X-ray and television dynamics of the bladder during discharge.
- Measure the amount of urine left in the bladder after emptying.
Among the recent important diagnoses for the success of the treatment are the peristaltic fluoroscopy of Ureter and the college’s nuclear examination to assess its functions (DMSA Renal Scan) and the detection if there are scars that have affected the kidney, as the last diagnosis is one of the most important modern diagnostic methods to determine the type of treatment for this the disease.
Treatment in the first stage is aimed at getting rid of the causes leading to this disease where if urinary reflux of the ureter disappeared or improved as a result of drug treatment, especially if the return is simple it is given to the infected child antibiotics that may last for two years with continuous and periodic follow-up to the sick child to exclude the occurrence of any infections that may arrive To the kidneys and cause scarring as we mentioned in advance or cause a deterioration in its functions, but if it proves a disappearance of urinary reflux after six months or a year from this treatment and after making sure of that by the diagnostic tests mentioned above, the cause is more often than the secondary causes that were mentioned Blood, especially bacterial infections or a narrowing of the lower urinary tract.
As for the treatment of urinary reflux disease in the second and third stages, which did not disappear during treatment with antibiotics during the two years mentioned above, it needs a modern endoscopic therapeutic intervention and the most successful at the present time and the simplest in practice for the affected child is the injection of endoscopic material in the junction of the ureter of the bladder. After the aforementioned procedure, one of the other pathogens or two of them are the cause and this is either congenital or as a result of secondary pathological changes which must be removed laparoscopically as well, so the speculative process should be the preferred treatment in this Stages of Flashback polycarbonate, since the lack of it has consequences for the ureters and kidneys.
As for the children who had mild reflux disease, i.e. they had a low degree of urinary reflux, and these children were given antibiotics for long periods of not less than two years, and they did not respond to treatment, these need the aforementioned endoscopic injection process or to perform a special laparoscopic process to fix the birth defect In the ureter or bladder if one of these congenital diseases is diagnosed.
Modern clinical statistics have proven that Simultaneous Endoscopic Therapy of the Reflux and OAB where NASHA-DX is injected under the ureter outlet to treat urinary reflux, and at the same time Botox A is injected into the cystic muscle (The Detrusor). ) In the case of a high-pressure nerve bladder, a small-capacity bladder and ureteral reflux in the second and third stage, with impaired kidney action of the ureteral reticulum and repeated infection of bacterial infections in the urinary tract, despite its treatment with antibiotics, especially in children with congenital neurological disease called hernia Of the spinal cord and its lesions (Myelomeningocele), where the concurrent endoscopic treatment of the ureter and the bladder, as well as the disappearance of the bladder, urethral and renal reflux, lead to the recovery of the child with nerve bladder disease (OAB), also called the high pressure nerve bladder, and at the same time these children also recover from urinary incontinence caused by the nerve bladder The first mentioned as well as the child gets rid of ureteral reflux and this is considered one of the medical and global advanced treatments that do not have complications or trouble for the child.