Causes of development and treatment options for developmental anomalies of the genitourinary system. Anomalies in the development of the urinary system. Treatment of congenital malformations of the urinary system.

The clinical significance of kidney development anomalies is determined by the fact that in 43-80% of cases they create conditions for the addition of secondary diseases that are more severe than in kidneys of normal structure. With anomalies in the development of the kidneys, chronic pyelonephritis develops in 72-81% of cases, and it has a persistent course, with it blood pressure often rises and renal failure quickly progresses [Trapeznikova M. F., Bukharkin B. V., 1979] The cause of the frequent occurrence of pyelonephritis with Most authors believe that renal anomalies are either congenital inferiority of the kidneys themselves, or a violation of uro- and hemodynamics, a combination of various types of renal anomalies with malformations of the lower urinary tract, in particular with vesicoureteral reflux.

Often, kidney abnormalities first appear during pregnancy, and the main disease for which patients are examined is pyelonephritis. We, together with M. S. Bazhirova, identified anomalies in the development of the urinary tract in 115 women. Most of them were admitted to the hospital for pyelonephritis that existed before pregnancy or occurred during it. Anomalies in the development of the kidneys were detected in 85 pregnant women, anomalies in the development of the ureters and bladder - in 20, anomalies in the development of the renal vessels - in 10. A double kidney was diagnosed in 30, a congenital single kidney - in 12, hypoplasia of the kidney - in 4, hydronephrosis - in 17, polycystic kidney disease - in 9, solitary kidney cyst in 4, spongy kidneys - in 2, fused kidneys - in 4, lumbar dystonia of the kidney - in 2, kidney rotation - in 1 patient.

Among the anomalies of the ureters and bladder, stricture of the ureter was most often observed (in 12), kinking of the ureter was in 2, duplication of the ureter in 1, megaloureter in 2, vesicoureteral reflux in 1 and malformations of the bladder (aplasia, atony, underdevelopment) - in 3 pregnant women. Anomalies in the development of the renal vessels in all 10 women consisted of unilateral or bilateral stenosis of the renal arteries. During pregnancy, 57 of 115 women experienced exacerbation of pyelonephritis, 12 had nephrogenic hypertension, and 9 patients had renal failure. An employee of the All-Russian Research Center for Healthcare and Healthcare, D. K. Kurbanov, who performed an ultrasound examination of pregnant women suffering from pyelonephritis, diagnosed 20 out of 161 women (12.4%) with anomalies in the development of the kidneys and renal vessels (anomalies of the lower urinary tract are not detected by this method).

Anomalies of kidney development are divided into 4 groups: anomalies of number, position, relationship and structure. According to A. Ya. Abrahamyan et al. (1980), the most common types of developmental anomalies are duplication of the kidneys, pelvis and ureters (23%), polycystic kidney disease (16.5%), lumbar dystopia (14.2%), horseshoe kidney (13.7%). Other types of anomalies are less common and range from 0.2 to 8.1% each. A combination of renal developmental anomalies with malformations of the musculoskeletal, cardiovascular and digestive systems was noted in 3.7% of patients, a combination with developmental anomalies of the genital organs - in 0.7%.

Abnormalities of quantity include renal aplasia, renal hypoplasia, duplication of kidneys, and additional third kidney.

About aplasia kidneys has already been discussed in the section “Pregnancy in women with one kidney.” It should be added that renal aplasia is usually accompanied by hypertrophy of the contralateral organ. When its function is normal, renal failure does not develop. A single kidney is more susceptible to various diseases than each of the normal kidneys. Infection of this single kidney is manifested by pain in the lumbar region, fever, pyuria, hematuria, and anuria. Renal failure develops in 25-63% of patients with a single congenital kidney. Of the 12 women with aplasia we observed, 1 had an abortion due to renal failure, 5 had a cesarean section for obstetric indications, 6 women had timely births.

Hypoplasia- congenital reduction in kidney size (Fig. 7). The kidney may be vestigial and dwarf.

Vestigial kidney- This is a sclerotic, small structurally and functionally underdeveloped organ.

Dwarf bud- normal kidney reduced in size.

The dysplastic form of the dwarf kidney is characterized by excessive development of fibrous tissue to the detriment of parenchymal tissue; such an anomaly is often accompanied by nephrogenic hypertension, often malignant. In 2 of 6 pregnant women with kidney hypoplasia observed by us, blood pressure was increased, 2 patients underwent nephrectomy of a non-functioning hypoplastic kidney; all 6 pregnant women had pyelonephritis, which worsened in 4 of them. 1 patient developed chronic renal failure. There were 5 timely births and 1 birth occurred prematurely, a stillborn child was born.

Kidney duplication- a common anomaly. An enlarged kidney could have doubled pelvis, vessels or ureters; there could be simultaneous doubling of all these elements - complete doubling of the kidney (Fig. 8, 9, 10). However, each of the halves of the kidney is, as it were, an independent organ, and the pathological process affects usually one of them.

These may be hydronephrosis, pyelonephritis, urolithiasis, tuberculosis. The cause of these double kidney diseases is most often vesicoureteral reflux. With ectopia of the accessory ureter into the vagina or cervix, involuntary urination is observed.

It is generally accepted that a double kidney is the least serious variant of developmental anomalies from the point of view of the course of pregnancy and childbirth. Our research shows that this is not the case. A double kidney during pregnancy is prone to the development of pyelonephritis (in 14 out of 30 women), and a persistent course of the disease is observed. Quite often (in 3 out of 30), a double kidney is accompanied by nephrogenic hypertension, which adversely affects pregnancy and fetal development. Many women with a double kidney develop late toxicosis of pregnancy (17 out of 30), which is often severe and difficult to treat. Therefore, pregnant women with a double kidney need clinical observation from a antenatal clinic physician and a urologist. Pregnancy is contraindicated in cases where the disease is accompanied by chronic renal failure.

Positional anomaly or dystopia can be pelvic, iliac, lumbar, thoracic and cross, unilateral or bilateral. Pelvic dystopia is the location of the kidney deep in the pelvis between the uterus and rectum. A bimanual examination in the vicinity of the posterior vaginal fornix reveals a dense, smooth formation. With dystopia of the kidney in the iliac fossa, pain may occur, often during menstruation. Upon palpation, the kidney may be mistaken for an ovarian cyst. The lumbar dystopic kidney can be palpated in the hypochondrium. Thoracic dystopia is a very rare anomaly and is an incidental finding during fluoroscopy. With cross dystopia, the kidney is displaced to the opposite side.

Dystopiakidney accounts for 1/5 of all anomalies of kidney development, with 2/3 of cases accounting for lumbar dystopia, which was also diagnosed in the patients we observed. Dystopic kidneys during pregnancy can manifest themselves as abdominal pain if they are affected by hydronephrosis, pyelonephritis, nephrolithiasis, and the lower the dystopia, the more often secondary kidney disease. In patients with kidney dystopia, intestinal activity may be impaired.

Pregnancy and childbirth are not special in all types of kidney dystopia, except pelvic. The location of the kidney in the pelvis can become an obstacle to natural delivery; in this case, a planned cesarean section is indicated. In the 4 patients with lumbar dystopia we observed, pregnancy was accompanied by the threat of termination in 3 women, the birth proceeded safely. With anomalies in the position of the kidneys, pregnancy is not contraindicated

Abnormalities of the relationship of the kidneys- this is the fusion of the kidneys with each other.

Various types of bud fusion give this conglomerate the shape of a biscuit-shaped, S-shaped, L-shaped and horseshoe-shaped kidney. Such kidneys are very susceptible to inflammation, hydronephrosis, and can be a source of renal hypertension. The causes of arterial hypertension in this case are chronic pyelonephritis, hydronephrosis, abnormal blood supply, and high intrarenal hypertension.

If there are abnormalities in the relationship, pregnancy is permissible if there is no secondary kidney damage. In 1 of 4 patients with an L-shaped kidney we observed, there were indications for termination of pregnancy, since often recurrent pyelonephritis occurred with chronic renal failure.

Abnormalities of the kidney structure include polycystic and multicystic kidneys, dermoid and solitary cysts, spongy kidney, pelvic diverticulum and peripelvic renal cyst.

Polycystic kidney disease- severe bilateral developmental anomaly.

The disease has a dominant type of inheritance. The kidney is an organ in which the parenchyma is almost completely replaced by multiple cysts of various sizes (Fig. 11). About 70% of babies with polycystic kidney disease are stillborn. With a small number of affected nephrons, children are viable, but renal failure develops when infection occurs and pyelonephritis develops. Polycystic kidney disease can be combined with polycystic disease of the lungs, ovaries, liver, and pancreas.

There are 3 stages of the clinical course of polycystic kidney disease:

• Stage I- compensated, manifested by dull pain in the kidney area, general malaise, minor functional disorders;
• Stage II- subcompensated, which is characterized by lower back pain, dry mouth, thirst, headache, nausea associated with renal failure and arterial hypertension;
• Stage III- decompensated, in which signs of chronic renal failure are expressed, the functional state of the kidneys is sharply depressed. This is confirmed by a decrease in the filtration and concentration capacity of the kidneys, retention of nitrogenous waste in the body, and anemia.

The kidneys are usually palpated as large, tuberous formations, always bilateral, unlike renal tumors. Patients begin to complain of lower back pain early. Hematuria appears in half of the patients.

The question of the advisability of continuing pregnancy with polycystic kidney disease is still debated. There is an opinion that pregnancy is contraindicated for this group of patients, since it worsens chronic pyelonephritis. D.V. Kahn (1978) argues against this view, arguing that in the absence of renal failure, pregnancy is acceptable. He pays attention to the age of patients, believing that it is better for them to give birth before the age of 25, since the symptoms of polycystic disease mainly appear at the end of the third or beginning of the fourth decade of life. All 6 observed D.V. Kan, patients with polycystic kidney disease gave birth safely the first time, but during the second pregnancy they developed arterial hypertension and eclampsia. N A Lopatkin and A L. Shabad (1985) consider pregnancy and childbirth extremely undesirable for women suffering from polycystic disease.

Due to the high probability of transmitting this defect to offspring, pregnancy should not be recommended for women suffering from polycystic kidney disease, since such patients develop early chronic renal failure, which is aggravated by the state of pregnancy and chronic nyelonephritis, which often complicates the course of polycystic disease. Half of the 9 patients we observed had an exacerbation of pyelonephritis, and half had chronic renal failure. In addition, polycystic kidney disease leads to the development of symptomatic arterial hypertension (in 5 out of 9 women), which also worsens the course of pregnancy and fetal development. 5 out of 9 pregnant women developed nephropathy, 1 had preeclampsia. Given these data and the hereditary nature of the disease, polycystic kidney disease should be considered a contraindication for pregnancy.

Solitary renal cyst- single cystic formation. The cyst can be congenital or acquired.

This anomaly is not hereditary and is unilateral. An increase in the size of the cyst leads to atrophy of the kidney parenchyma, impaired hemodynamics in the kidney and the development of arterial hypertension. Patients complain of dull pain in the lower back. The enlarged kidney is palpable. Pyuria or hematuria is observed. In the absence of renal hypertension, pregnancy is not contraindicated. All 4 patients we observed with this form of kidney anomaly gave birth safely

Sponge bud- an anomaly in which numerous cysts form in the renal pyramids.

The disease is bilateral, manifested by hematuria, pyuria, and pain in the lumbar region. Kidney failure usually does not develop. Pregnancy with this kidney anomaly is not contraindicated. We observed 2 patients whose pregnancy and childbirth proceeded well, despite the exacerbation of pyelonephritis during pregnancy.

Multicystic kidney, dermoid cyst of the kidney, diverticulum of the pelvis and peripelvic cyst- very rare developmental anomalies.

Congenital hydronephrosis in the 17 pregnant women we observed was caused by stricture of the ureteropelvic segment (in 10), kinking of the ureter (in 3), reflux in (1) and anomalies of the renal vessels. A special section of this chapter is devoted to hydronephrosis.

Abnormalities of the ureters and bladder are as varied as abnormalities of the kidneys. Aplasia of the pelvis and ureter is observed as a component of renal aplasia, doubling of the pelvis and ureter, sometimes combined with complete doubling of the kidney.

Ureterocele- intravesical hernia-like protrusion of the intramural part of the ureter.

Ureterocele can cause dilatation of the upper urinary tract, pyelonephritis, and urolithiasis.

Ectopic ureteral orifice- abnormal location of the ureteric orifice in the posterior part of the urethra, vaginal vault, in the area of ​​the external genitalia or rectum.

This anomaly is characterized by constant incontinence of urine from one ureter and entry into the bladder from the second ureter with periodic natural emptying of the bladder. Neuromuscular dysplasia of the ureters (megaloureter) is a combination of congenital narrowing of the ureteric orifice with neuromuscular dysplasia of lower cystosis. The overlying parts of the ureter expand and lengthen, forming the megaloureter. The kinetics of the ureter is sharply disrupted, contractility is slow or absent.

All variants of developmental anomalies of the ureters contribute to impaired urodynamics, the development of pyelonephritis, hydronephrosis, and renal failure. Among the 17 patients we observed with ureteral anomalies, 12 had ureteral stricture, which resulted in hydronephrosis in 6 pregnant women with renal failure in 1 of them. Vesicoureteral reflux was detected in 2 patients: in one it was combined with hydronephrosis, in the other with narrowing and kinking of the ureter. 2 patients had megaloureter, 1 had duplication of the ureter. All women suffered from chronic pyelonephritis, and 12 out of 16 had an exacerbation of pyelonephritis during pregnancy, and 1 had renal failure. All women were able to achieve pregnancy except the patient with renal failure. 2 patients underwent cesarean section for obstetric indications.

Anomalies in the development of the bladder.

Meet bladder duplication, bladder diverticulum- saccular protrusion of the wall, bladder exstrophy- absence of the anterior wall of the bladder, etc. We observed 3 pregnant women with aplasia of the bladder, its atony and underdevelopment.

All of the women we observed with anomalies in the development of the bladder and some of the patients with anomalies in the development of the ureter underwent corrective urological operations, which improved their condition and allowed them to endure pregnancy and childbirth. It should be noted that their condition worsened during pregnancy and the difficulty of resolving the issue of the method and timing of delivery in case of bladder anomalies. One patient with aplasia of the bladder and transplantation of the ureters into the rectum had to undergo a minor cesarean section at 30 weeks of pregnancy; another, who underwent bladder surgery, had a cesarean section during a full-term pregnancy. Observations of the course of labor in women with developmental anomalies of the ureters and bladder are few, and tactics for managing pregnancy and childbirth have not been developed. In most cases, it is necessary to decide individually for each patient the question of the possibility of continuing pregnancy, the timing and method of delivery.

Diagnosis of anomalies in kidney development is based on data from chromocystoscopy, ultrasound, excretory urography, pneumo-retroperitoneum, radioisotope scanning of the kidneys. During pregnancy, only the first two methods are permissible. With anomalies in the development of the ureters, the echocardiographic method is not informative, so it is almost impossible to diagnose them during pregnancy; the diagnosis is made before pregnancy or retrospectively during examination after childbirth.

In addition to kidney and urinary tract abnormalities, there are abnormalities in the development of renal vessels, which affect kidney function and the woman’s health, and therefore can affect the gestational process. Accessory, double or multiple renal arteries, arteries with an atypical direction, as well as additional or atypically directed veins, compress the ureters, disrupting urodynamics and contributing to the formation of hydronephrosis, urolithiasis, pyelonephritis and nephrogenic hypertension. A. A. Spiridonov (1971) believes that in the development of arterial hypertension with multiple renal arteries, 3 factors that cause activation of the renin-angiotensin system can play a role:

1. damping of the pulse wave as it passes through several small arteries;
2. discrepancy between blood flow and venous outflow;
3. urodynamic disorders.

Anomalies in the development of renal vessels can be diagnosed by angiography and aortography, which are unacceptable during pregnancy. Therefore, the diagnosis is usually made before pregnancy. In pregnant women, only ultrasound examination in some cases helps in diagnosis. As a rule, the diagnosis must be confirmed after childbirth or termination of pregnancy using x-ray methods.

We observed 10 women with renal artery stenosis due to fibromuscular hyperplasia. The first 4 patients were described in the book by M. M. Shekhtman, I. Z. Zakirov, G. A. Glezer “Arterial hypertension in pregnant women” (1982; Renal artery stenosis causes a consistently high (200-250/120-140 mm Hg Art., or 26.7-33.3/16.0-18.7 kPa) blood pressure, not corrected by drug therapy. Pregnancy usually ends in intrauterine fetal death or spontaneous abortion. Therefore, the only correct solution is termination of pregnancy and surgical treatment renovascular hypertension. Resection or plastic surgery of the renal artery (sometimes bougienage) leads to normalization of blood pressure and a successful pregnancy and childbirth. All the women we observed after the operation gave birth to live children, one of them three times.

The commonality of embryogenesis of the urinary and genital organs creates the prerequisites for the development of anomalies in both systems.

N. A. Lopatkin and A. L. Shabad (1985) believe that the combination of developmental anomalies in both systems reaches 25-40%, and point to the following patterns: the existence of an internal dependence of the organogenesis of the urinary and genital organs in women; the side of the kidney development anomalies coincides with the side of the genital anomalies. This combination of anomalies of the two systems is explained by unilateral or bilateral disruption of the development of the mesonephric and paramesonephric ducts in ontogenesis. E. S. Tumanova (1960) found kidney anomalies in every 5th woman with anomalies of genital development.

Among the women we observed with anomalies in the development of the urinary organs, 6 (8%) had malformations of the genital organs. 2 women with aplasia of the kidney had a saddle-shaped uterus, 1 had a septum in the vagina, 1 woman with megaloureter had a bicornuate uterus, a woman with underdevelopment of the bladder had a saddle-shaped uterus, and a patient with aplasia of the bladder had a septum in the vagina.

Combined pathology poses new tasks for the obstetrician-gynecologist observing a pregnant woman, makes changes in the tactics of pregnancy and childbirth, and affects the prognosis of pregnancy outcome, so clarifying the situation is of great importance. Since it is impossible in most cases during pregnancy, it should be performed before pregnancy, during the observation of women in the antenatal clinic for some other reason.

Treatment of developmental anomalies of the urinary tract is surgical. It is not carried out during pregnancy. In pregnant women, treatment is carried out for complications such as pyelonephritis, arterial hypertension and renal failure.

Frequency: found in approximately 1% of the population, diagnosed prenatally in approximately 0.2% of children.

Attention: 30% of prenatal diagnoses are not confirmed, so monitoring after birth is necessary.

Forms:

• Hydronephrosis: disturbance of bladder emptying (eg, urethral valve).
• Polycystic kidney disease.
• Congenital megaloureter, duplication.
• Vesicoureteral reflux.
• Agenesis/aplasia of the kidneys.
• Prune-Belly syndrome (syn.: aplasia syndrome of the abdominal wall membranes, “plum belly” syndrome),
• Bladder exstrophy.

Complications and problems: severe and prolonged intrauterine obstructive uropathy leads to shrinkage of the kidney (sometimes already in utero).

First aid if you suspect a defect of the urinary system:

• Forced postnatal diagnosis.
• Diuresis counting and urine collection. Urine is excreted in the first 24 hours in 92% of mature and 90% of immature newborns, and within 48 hours - in 99%.
• With the valve, if necessary, a suprapubic puncture of the bladder is performed (unloading the bladder and kidneys).

Attention: from the kidneys there are practically no emergency conditions in the delivery room, but there may be pulmonary hypoplasia (with oligo- or ahydramnios). With kidney disease, spontaneous pneumothorax can occur even with spontaneous breathing.

First aid with bladder exstrophy:

• Immediately place on a sterile diaper.
• Moisturizing the eventrated parts.
• Constant assessment of the eventrated bladder: color, hemorrhage, swelling.
• Wrapping up the eventured tea! in a sterile plastic bag or moisturize with sterile Vaseline.
• Don't forget to weigh your baby.
• Emergency (up to 24-48 hours) surgery.
• Examination of the proximal urinary tract.

Hypospadias

Definition: a malformation of the penis with incomplete development of the urethra and an abnormally located opening on the lower part of the penis, on the scrotum or on the perineum. Malformation of the spongy part of the urethra with or without curvature, ventral defect of the foreskin and hypertrophy of the dorsal foreskin.

Tactics depend on the location of the external opening:

• Capitate, stem, scrotal, perineal forms.
• With or without stenosis.
• With or without head deformation.
• “Hypospadias without hypospadias” is a curvature without significant dislocation of the foramen.

Combined with vices:

• Cryptorchidism and inguinal hernia - about 9% of cases.
• Utriculus prostaticus masculinus - about 11% of cases (in severe forms).
• Kidney and urinary system defects - 3%.

Differential diagnosis with intersexuality, hypogenitalism; if necessary, determine the karyotype.

Treatment:

• Correction is indicated in all cases of trunk curvature, stenosis of the foramen, and localization of the foramen proximal to the coronary groove.
• In distal forms, the indications are determined by aesthetic disorders, but not in the newborn period!

Hydrocele (dropsy)

Hydrocele (dropsy): Persistence of a patent processus vaginalis can lead to the accumulation of peritoneal fluid within the processus vaginalis.

Definition: a fluid-filled cyst in the area of ​​the testicular membranes or spermatic cord.

Shapes:

• Hydrocele of the cord.
• Hydrocele of the testicle: the testicle is most often not palpable.
• Inguinoscrotal hydrocele: the upper pole of the cyst reaches the abdominal cavity. A dense formation is palpated medial to the inguinal ligament in the small pelvis. When pressing on the scrotum, its volume increases.
• With communicating dropsy (the size changes), there is a connection with the abdominal cavity. The clinic and treatment correspond to an inguinal hernia.
• Nuco canal cysts (in girls): localized accumulations of fluid in the area of ​​the round ligament outside the inguinal canal.

Clinic:

• Various sized asymptomatic unilateral or bilateral tumor-like formations in the testicular area.
• Often found in newborns. Spontaneously regresses during the first 3-4 months of life.
• They can appear spontaneously without an obvious reason outside the neonatal period, and they can also regress.
• After the first year of life, dropsy occurs in less than 1% of boys.

Diagnostics:

• Examination, palpation.
• Diaphanoscopy does not allow distinguishing a hydrocele from a strangulated hernia.

Differential diagnosis: strangulated hernia, scrotal hernia, varicocele, testicular torsion.

Important: Testicular torsion can also be congenital; this is an indication for immediate surgery.

Treatment:

• The operation is indicated after six months for persistent hydrocele.
• In the first 3 months, surgery is performed only for large size, rapid increase in volume and inguinal-scrotal hydrocele.

Inguinal hernia

Formed as a result of persistence of the vaginal process of the peritoneum. A sufficiently large size of the hole allows intestinal loops to penetrate into the appendix.

Definition: parts of the intestine emerge from the abdominal cavity through a congenital or acquired opening (hernial orifice), surrounded by the parietal peritoneum. The contents of the hernia are limited to the membranes of the hernia (subcutaneous tissue, skin or wall of the scrotum). Children's inguinal hernias are always indirect. They are formed along the inguinal canal (persistence of the processus vaginalis).

Clinic:

• Most often, there are asymptomatic, soft, reducible tumors in the groin medial to the inguinal ligament (inguinal hernia), which may reach the scrotum (scrotal hernia).
• When strangulated, the hernia becomes painful and irreducible.

Diagnostics:

• Clinical difference from hydrocele: with an inguinal hernia, the hernial sac is palpated above the inguinal ring, but with a hydrocele it does not reach it. In doubtful cases, treatment is always carried out as for a strangulated hernia.
• Sonography.

Differential diagnosis: testicle in the inguinal canal, lymphadenitis, hydrocele of the testicle or cord, testicular torsion, varicocele.

Complications:

• Potentially life-threatening condition.
• Intestinal strangulation or peritonitis.
• Loss of a testicle/ovary or section of intestine.

Infringement: in approximately 12% of cases, but 70% in the 1st year of life:

• Clinic: sudden onset of illness, severe pain, anxiety, symptoms of peritoneal irritation.
• Findings: elastic-elastic, tense, sedentary inguinal or inguinoscrotal tumor.

Treatment and indications for surgery:

• Reduction of an inguinal hernia often occurs independently.
• Active reduction (under sedation) is possible no later than 6-8 hours from the onset in the absence of symptoms of shock
• If reduction is unsuccessful, urgent surgery is indicated.
• Elective surgery after successful reduction.
• In all other cases, early hernia repair is optimal so that the risk of anesthesia does not increase.

Umbilical hernia

Umbilical hernia: a defect in the umbilical fascia covered by skin. Surgical intervention is very rarely required, since the defect closes over time (by 1 year of life). Pinching or damage to the skin due to pressure is extremely rare.

CONTENTS:

Kidney anatomy

Embryogenesis:

Main features of embryogenesis of the kidneys and ureters

Merged Müllerian ducts (9 weeks)

DEVELOPMENT OF THE GENERAL SYSTEM The Wolffian canal takes part in the development of the male reproductive system, and the Müllerian canal takes part in the development of the female reproductive system.

Developmental anomalies

Kidney anatomy

Kidney anatomy

Kidney anatomy

Kidney anatomy

Renal vascular abnormalities

84,6%

Accessory and multiple renal veins:

O.11%

Fibromuscular stenosis:

Kidney abnormalities

Kidney abnormalities are divided into 5 groups:

Classification (N.A. Lopatkina)

Aplasia:

0,083% 1:1200

Kidney number abnormalities

Kidney number abnormalities

Accessory (third) kidney:

Accessory kidney

Magnitude anomalies

Renal hypoplasia

Classification

2,8%

Thoracic dystopia of the kidney

Anomalies in the location of the kidneys (dystopia)

Lumbar kidney dystopia

Anomalies in the location of the kidneys (dystopia)

Ilial dystopia

Anomalies in the location of the kidneys (dystopia)

Pelvic dystopia

Anomalies in the location of the kidneys (dystopia)

Cross Dystopia

ANOMALIES OF KIDNEY RELATIONSHIP:

Relationship anomalies

Biscuit bud

S-shaped and L-shaped kidneys

Relationship anomalies

0,25%

Horseshoe kidney:

Horseshoe kidney

Classification

Anomalies of structure

Kidney dysplasia

Anomalies of structure

Multicystic kidney:

Multicystic kidney disease

Anomalies of structure

Solitary renal cyst:

Solitary renal cysts

Anomalies of structure

Spongy bud:

Spongy kidney (overview photo)

Polycystic kidney disease:

Polycystic kidney disease

Anatomy of the ureters

Histological structure of the ureter.

URETER ANOMALIES:

Duplication of the pelvis and ureter:

13,4%

Retrocaval ureter:

0,21%

Ureterocele:

Ectopic ureteral orifice:

Abnormalities of the urethra:

Hypospadias

Abnormalities of the urethra

Hypospadias:

"hypospadias without hypospadias"

4 types of "hypospadias without hypospadias"

Diagnosis of hypospadias

Treatment

Abnormalities of the urethra

Epispadias

Epispadias:

Epispadias of the glans penis

Stem form of epispadias

Total (complete) epispadias

Treatment

Abnormalities of the urethra

Congenital urethral valves

Congenital obliteration of the urethra

Bladder exstrophy:

Testicular abnormalities (5-7%)

Cryptorchidism:

Anorchism

Polyorchidism

Testicular hypoplasia

Penile abnormalities

Congenital phimosis:

Phimosis

Paraphimosis

Hidden penis

Short frenulum of the penis

The urinary tract begins with the renal pelvis and ends with the urethral opening.

Congenital malformations (anomalies) of the urinary tract

Congenital anomalies of the urinary tract are closely related to identical kidney anomalies. If a patient has two kidneys, there are three ureters on one side. In the case of unilateral renal agenesis, the ureter itself is correspondingly absent. Along with the presence of a double kidney, urethrocele is also quite common - protrusion of the urethra through the vaginal wall, resulting in the formation of a bulbous swelling. The ureter may have narrowings, possibly also in the case of a blind branch. In addition, it is possible that the ureter does not end in the ureter, but, for example, flows into the seminal vesicles or into the urethra itself.

Congenital malformations (anomalies) of the bladder

When the urinary duct is not closed during development, quite often a cyst begins to form in it. It is also possible to form a bladder diverticulum - a funnel-shaped or sac-like protrusion of the organ wall. All of the above anomalies are not accompanied by illness. One of the most severe malformations of the urinary tract is exstrophy of the bladder, which is manifested by damage not only to the bladder, but also to the anterior wall of the peritoneum, urethra and pelvic bones. If there is no treatment for these anomalies, the patient dies.

Congenital anomalies of the urethra

Epispadias is a developmental defect (anomaly) of the penis, in the presence of which the opening of the urethra, which is intended for the removal of urine, is located on the upper part of the penis. Female representatives also often have malformations of the bladder and clitoris. Hypospadias is a disease in which the external (excretory) opening of the urethra is located on the lower part of the penis.

Symptoms of kidney abnormalities:

urinary disturbance;

growth disorder;

pain in the side and abdomen;

frequent urinary tract infections.

Causes of urinary tract abnormalities

All of the above anomalies of the urine extraction system from the body are congenital. Accordingly, they can arise as a result of a genetic defect or as a result of exposure to harmful factors on the fetus during gestation.

Treatment of anomalies of the genitourinary system

In most cases, treatment is surgical. Of course, when the congenital anomaly does not interfere with the flow of urine, treatment is not critically necessary.

Self-medication in the presence of congenital anomalies of the urinary tract is strictly prohibited.

Diagnosing anomalies in young children is extremely difficult. Parents should remember the main symptoms of congenital anomalies of this body system and monitor them as the child grows. This is an increase in body temperature of unknown origin, lack of appetite. These and other ailments, when identified, must be discussed with the pediatrician and, if necessary, diagnostics performed.

If there is a suspicion of a congenital anomaly of the urinary system, a blood test and ultrasound examination of the pelvic organs are prescribed. In addition to a blood test, an X-ray examination with the introduction of a contrast agent may also be prescribed to accurately determine the location of the anomaly.

Course of the disease

The vast majority of congenital malformations of the urinary tract are diagnosed accidentally (except for those that can be visualized with the naked eye) during examination of the patient for other reasons; usually such pathologies do not cause negative consequences in the future, but there are a number of cases of severe pathologies, for example, bladder exstrophy, which require emergency complex treatment.

Modern therapy for anomalies of the urinary system is possible only if the pathology is diagnosed early, so every child must undergo all mandatory preventive examinations.

Introduction

The urinary system is a collection of organs that produce and secrete urine. The urethra is the tube that carries urine from the productive areas of the kidneys to the bladder, where it is stored and then discharged through a canal called the urethra. With congenital abnormal development (anomalies) of the urinary system, either the production or excretion of urine is impaired.

Defects of the urinary system vary in severity from minor to life-threatening. Most are serious, requiring surgical correction. Other defects do not cause dysfunction of the urinary system, but make it difficult to control urination.

The greatest number of complications occurs when there is a mechanical obstruction to the outflow of urine; urine stagnates or returns (returns) to the upper parts of the urinary system. The tissue in the area of ​​the mechanical obstruction swells and as a result the tissue is damaged. The most serious damage is to the kidney tissue, leading to impaired renal function.

Obstruction (mechanical obstruction) is a relatively rare pathology. Boys get sick more often. In girls, obstruction most often occurs at the branch of the urethra from the kidney or between the urethra and the bladder wall; in boys - between the bladder and urethra. Obstruction in the upper urinary system most often occurs on the right.

Among the complications of obstruction, the most common are infectious processes and the formation of kidney stones. To avoid their development, surgical intervention is indicated. Surgical interventions are more successful in infancy. In the absence of surgery for up to 2-3 years, kidney damage and impairment of their function are inevitable.

Another type of developmental anomaly is the absence or duplication of some organs of the urinary system, their incorrect location, and the presence of extra holes. In second place among the anomalies is exstrophy (defect of the bladder, anterior abdominal wall, umbelical ligaments, pubic region, genitals or intestines) and epispadias (defect of the penis and urethra).

Most children who develop a urinary obstruction are born with structural abnormalities of the urinary tract; There may be an overgrowth of tissue in the urethra or a pocket in the bladder, an inability of any part of the urethra to move urine to the bladder. Possible damage to the urethra due to trauma to the pelvic organs.

The urinary tract is formed in the early stages of fetal formation (the first 6 weeks after fertilization); the resulting defects can arise from a number of factors affecting the fetus, although the exact mechanism of their occurrence remains unclear. It has been established that the percentage of defects is higher in children born to mothers who abused drugs or alcohol.

The formation of kidney stones during blockage of the urinary system can be due to a number of other reasons, however, once formed, kidney stones, in turn, increase the obstruction to the outflow of urine.

Quality anomalies

genitourinary agenesis kidney dystopia

Anomalies of the urinary system are disorders in the development of organs of the genitourinary system that do not allow the body to function normally.

It is believed that most often anomalies of the urinary system arise due to the influence of hereditary factors and various negative effects on the fetus during intrauterine development. Anomalies of the urinary system can develop in a child due to rubella and syphilis suffered by the mother in the first months of pregnancy. The occurrence of abnormalities can be provoked by the mother's alcoholism and drug addiction, her use of hormonal contraceptives during pregnancy, as well as medications without a doctor's prescription.

Anomalies of the urinary system are divided into the following groups:

Ø Anomalies in the number of kidneys - bilateral agenesis (absence of kidneys), unilateral agenesis (single kidney), double kidneys;

Ø Anomalies in the position of the kidneys - momolateral dystopia (the drooping kidney is on its side); heterolateral crossed dystopia (movement of the kidney to the opposite side);

Ø Anomalies in the relative position of the kidneys (fused kidneys), horseshoe-shaped kidney, biscuit-shaped kidney, S-shaped, L-shaped;

Ø Anomalies in the size and structure of the kidneys - aplasia, hypoplasia, polycystic kidney;

Ø Anomalies of the renal pelvis and ureters - cysts, diverticula, bifurcation of the pelvis, anomalies in the number, caliber, shape, position of the ureters.

Many of these anomalies cause the development of kidney stones, inflammation (pyelonephritis), and arterial hypertension.

The influence of various forms of anomalies of the urinary system on the child’s body can be expressed in different ways. If some disorders most often lead to intrauterine death of a baby or his death in infancy, then a number of anomalies do not have a significant effect on the functioning of the body, and are often discovered only by chance during routine medical examinations.

Sometimes an anomaly that does not bother a child can cause serious functional disorders in adulthood or even old age.

It is believed that the risk of developing such disorders is highest in the first months of pregnancy, when the main organs, including the urinary system, are formed. The expectant mother should not take any medications without a doctor's prescription. In case of colds and other diseases that involve high fever and intoxication, you should immediately go to the hospital.

When planning a pregnancy, young parents are advised to undergo a medical examination, which will rule out various diseases that lead to abnormalities in the fetus. If there have already been cases of anomalies in the family, consultation with a geneticist is necessary.

Cloaca exstrophy

Exstrophy (turning of a hollow organ outward) of the cloaca is a defect in the development of the lower part of the anterior abdominal wall. (The cloaca is the part of the germ layer from which the abdominal organs ultimately develop.) A baby with cloacal exstrophy is born with multiple defects of internal organs. Part of the colon is located on the outer surface of the body, on the other side there are two halves of the bladder. Boys have a short and flat penis, girls have a split clitoris. Cases of such a gross anomaly occur: 1 in 200,000 live newborns.

Despite the severity of the defect in cloacal exstrophy, newborns are viable. The bladder can be repaired surgically. The lower colon and rectum are underdeveloped, so a small stool receptacle is surgically created on the outside.

Bladder exstrophy

Bladder exstrophy is a congenital anomaly of the urinary system, characterized by inversion of the bladder outward from the abdominal wall. This pathology occurs in 1 in 25,000 children, 2 times more often in boys than in girls.

In all cases, bladder exstrophy is combined with an anomaly of the external genitalia. Epispadias occurs in boys; in 40% of boys with exstrophy of the bladder, the testicles are not descended into the scrotum, the penis is short and flat, thicker than usual, attached to the outer abdominal wall at an incorrect angle.

In girls, the clitoris is cleft, the labia (the protective folds of skin around the vaginal and urethral openings) may be widely separated, and the vaginal opening may be very small or absent. Most girls with this pathology are capable of conceiving a child and giving birth naturally.

Exstrophy of the bladder in both boys and girls is usually combined with an anomaly in the location of the rectum and anus - they are significantly displaced forward. Rectal prolapse is a consequence of its location, when it can easily slip out and can also be easily retracted. Bladder exstrophy may be associated with a low umbilicus and lack of cartilage connecting the pubic bones. The latter circumstance, as a rule, does not affect the gait.

Progress in surgical technology allows, in most cases, to reliably correct this type of developmental defect.

Epispadias

Epispadias is a developmental defect characterized by an abnormal location of the opening of the urethra. In boys with epispadias, the opening of the urethra is located on the upper side of the penis, at the root where the anterior abdominal wall begins. In girls, the opening of the urethra is normally located, but the urethra is wide open. Epispadias is often combined with bladder exstrophy. As an isolated defect, epispadias occurs in 1 in 95,000 newborns, and is 4 times more common in boys than in girls.

Pyeelectasis

Pyeelectasia is an enlargement of the renal pelvis. The explanation of the origin of the term “pyelectasia” is very simple. Like most complex medical names, it is derived from Greek roots: pyelos - “trough”, “tub”, and ektasis - “stretch”, “stretch”. The stretching is understandable, but what is called the “tub” needs to be dealt with.

Pyeelectasia is one of the most common structural anomalies that are detected during ultrasound examination of the urinary system. An ultrasound diagnostic doctor usually does not have specialized information in the field of nephrology, he works in his area of ​​expertise, so his report contains the phrase: “Consultation with a nephrologist is recommended,” and you get an appointment with a nephrologist. Most often, pyeloectasis is found during ultrasound during pregnancy, before the baby is born, or in the first year of life. Therefore, it would not be a big mistake to attribute the expansion of the pelvis to congenital structural features.

But the expansion of the pelvis may appear later. For example, at 7 years of age, during a period of intensive child growth, when the location of organs relative to each other changes, the ureter may be compressed by an abnormally located or accessory vessel. In adults, dilation of the pelvis may be a consequence of blocking the lumen of the ureter with a stone.

Causes of pyelectasis: expansion of the pelvis occurs when there is an obstacle (difficulty) in the outflow of urine at any stage of its excretion. Difficulty in the flow of urine may be due to:

· with any problems associated with the ureters, such as: developmental anomaly, bending, compression, narrowing, etc.;

· with permanent or temporary (with improper preparation for ultrasound) overfilling of the bladder. With constant refilling of the bladder, the child goes to urinate very rarely and in large portions (one of the types of neurogenic bladder dysfunction);

· with the presence of an obstruction in the passage of urine into the bladder from the ureter or in its excretion through the urethra;

· with blockage of the ureter by a stone, tumor or clot of pus (more often in adults);

· with some physiological ones, i.e. normal processes in the body (for example, excessive fluid intake), when the urinary system simply does not have time to remove all the absorbed fluid;

· with a normal, but rarer type of location of the pelvis, when it is not inside the kidney, but outside it;

· with urine reflux from the bladder back into the ureters or kidney (reflux);

· with infection of the urinary system due to the action of bacterial toxins on the smooth muscle cells of the ureters and pelvis. According to researchers, in 12.5% ​​of patients with pyelonephritis, the pyelocaliceal system expands. After treatment, these changes disappear;

· with general weakness of the muscular system in case of prematurity of the baby (muscle cells are part of the ureters and pelvis);

· with neurological problems.

Pyeelectasis is curable if diagnosed correctly and adequate treatment is prescribed. Another thing is that in some cases with pyeloectasia, independent recovery is possible, associated with the growth of the baby, a change in the position of the organs relative to each other and the redistribution of pressure in the urinary system in the right direction, as well as with the maturation of the muscular system, which is often underdeveloped in premature babies.

The first year of life is the period of the most intense growth: organs grow at tremendous speed, their position relative to each other changes, and body weight increases. The functional load on organs and systems increases. That is why the first year is decisive in the manifestation of most developmental defects, including defects of the urinary system.

Less intense growth, but also significant for the manifestation of developmental anomalies, is observed during the period of the so-called first extension (6-7 years) and in adolescence, when sharp increases in height and weight and hormonal changes occur. That is why pyeloectasia detected in utero or in the first months of life is subject to mandatory observation in the first year of life and during the listed critical periods.

You should be wary:

· pelvis size 7 mm or more;

· change in the size of the pelvis before and after urination (during ultrasound);

· changes in its size throughout the year.

Quite often, having discovered a pelvis size of 5-7 mm in a child after 3 years of age and having observed him for a year or two, experts come to the conclusion that this is just an individual deviation from generally accepted structural norms, which is not associated with a serious problem.

The question is completely different if this deviation is determined in the baby in utero or immediately after birth. If the size of the child’s pelvis in the 2nd trimester of pregnancy was 4 mm, and in the 3rd trimester - 7 mm, constant monitoring is required. Although it must be said that in most babies, after birth, the expansion of the pelvis disappears. Accordingly, there is no need to worry, but observation is simply necessary.

Pyeelectasia is primarily associated with increased pressure in the pelvis, which cannot but affect the kidney tissue adjacent to it.

Over time, part of the kidney tissue is damaged under constant pressure, which, in turn, leads to disruption of its functions. In addition, due to the high pressure in the pelvis, the kidney requires additional effort to remove urine, which “distracts” it from its immediate work. How long can the kidneys work in such an enhanced mode?

For low-grade pyeloectasia (5-7 mm), control ultrasounds of the kidneys and bladder are performed once every 1-3 months. (frequency is determined by a nephrologist) in the first year of life, and in older children - once every 6 months.

When an infection occurs and (or) when the size of the pelvis increases, an X-ray urological examination is performed in a hospital setting. Usually this is excretory urography, cystography. These examinations allow us to determine the cause of pyelectasis. Of course, they are not absolutely harmless and are carried out strictly when indicated and according to the decision of the supervising doctor - a nephrologist or urologist.

There is no single, universal treatment for pyeloectasia; it depends on the established or suspected cause. So, if there is an abnormality in the structure of the ureter and (or) with a sharp increase in the size of the pelvis, your baby may need surgical treatment aimed at eliminating the existing obstacle to the outflow of urine. In such cases, the wait-and-see approach that some parents follow may result in loss of the kidney, although it can be saved.

In the absence of a sharp deterioration and visible disorders (according to ultrasound, urine tests, etc.), another tactic may be proposed: observation and conservative treatment. It usually includes physiotherapeutic procedures, taking (if necessary) herbal medications, and ultrasound monitoring.

Let's summarize:

· Pyeelectasia is not an independent disease, but can only serve as an indirect sign of a violation of the outflow of urine from the pelvis as a result of some structural anomaly, infection, reverse reflux of urine, etc.

· During the period of intensive growth, mandatory monitoring of changes in the size of the pelvis is required. The frequency of control examinations is determined by the nephrologist.

· Since the kidney is a paired organ, pyeloectasia can be unilateral or bilateral.

· Pyeelectasia can be a consequence of a urinary tract infection and, conversely, can itself contribute to the development of inflammation.

· With general immaturity of the body (in premature babies or babies with central nervous system problems), the size of the pelvis may return to normal as problems with the central nervous system disappear. In this case, the terms “hypotension of the pelvis” or “agony” are sometimes used.

· Pyeelectasis requires mandatory observation by a nephrologist and ultrasound monitoring.

· In most cases, pyeelectasis is transient, i.e., a temporary condition.

· Treatment is prescribed depending on the cause of pyeloectasia, together with a nephrologist (urologist).

Increased kidney mobility and nephroptosis

Abnormalities in kidney development may not make themselves felt, but may manifest as persistent abdominal pain. It can be difficult even for a specialist to detect the source of the problem, since in many cases nothing can be detected during examination, and all tests are normal. But thanks to ultrasound, it has become possible to quickly and painlessly detect abnormalities in the functioning of the kidneys, although they are often discovered by chance.

Currently, increased kidney mobility and nephroptosis (more pronounced kidney mobility) are quite often diagnosed. As the name suggests, the problem is due to excessive movement of the kidney.

Normally, the kidneys can perform a certain amount of movement during breathing; moreover, the absence of such kidney mobility can be a sign of a serious disease.

The kidneys are located behind the peritoneum, coming closest to the surface of the body from the back. They lie in a special fat pad and are fixed by ligaments. Why has the number of cases of excessive kidney mobility and nephroptosis increased so much? The point, of course, is not only that new examination methods have appeared, in particular ultrasound. Most often, this problem occurs in thin children and adolescents. It is in them that the adipose tissue that creates the bed for the kidney is practically absent, just as there is little of it in the entire body. Therefore, first of all, it is necessary to find out the cause of low body weight in a child, especially if he complains of headaches, fatigue, etc. In teenage girls, a sharp decrease in body weight is often associated with the desire to be like supermodels: girls go on diets that almost They don’t eat anything, although it is precisely during the period of hormonal changes in the body that fasting is extremely harmful. Often the appearance of nephroptosis is associated with a sharp jump in growth at 6-8 and at 13-17 years, when increased nutrition is required.

Increased mobility of the kidneys is most often manifested by unpleasant sensations and (or) heaviness in the lumbar region, and periodic headaches.

Nephroptosis is a more severe form of mobility. There are 3 degrees of kidney mobility. In the most severe stage III, the kidney is located at the level of the bladder or slightly above it.

The child complains of frequent and persistent abdominal pain! In addition, improper flow of urine from the kidneys leads to infection of the urinary system. Often, with nephroptosis, pressure surges are observed, and therefore adolescents are often diagnosed with “vegetative-vascular dystonia.” Although, in fact, the increase in pressure occurs due to the constant stretching of the vessels that feed the kidneys. In addition to this, the highly mobile kidney itself is poorly supplied with blood and tries to compensate for the inability to work during the day by working at night, when it returns to its normal place, and therefore more urine is produced at night than necessary.

Since a highly mobile kidney changes its location, including periodically returning to its “starting position,” it is necessary to conduct an extended ultrasound of the kidneys to determine their mobility: examining the patient in a lying position, then standing, and in some cases after physical activity (for example, after a series of jumps).

If an ultrasound scan shows the presence of nephroptosis, an x-ray urological examination is required to determine the degree of nephroptosis and possible abnormalities in the structure of the urinary tract.

Quantity anomalies

Renal agenesis

Mention of kidney agenesis is found in Aristotle: he wrote that an animal without a heart cannot exist in nature, but without a spleen or with one kidney they are found. The first attempt to describe aplasia in humans belongs to Andreas Vesalius in 1543. In 1928, N. N. Sokolov identified the frequency of aplasia in humans. As a result of his research, he analyzed 50,198 autopsies and found renal agenesis in 0.1% of cases. According to his data, the frequency of occurrence does not depend on the gender of the person. Modern scientists, based on a fairly large sample, give slightly different numbers. According to their data: the incidence of agenesis is 0.05%, and it occurs three times more often in males.

general information

Agenesis (aplasia) of the kidneys is a malformation of the organ during embryogenesis, as a result of which one or both kidneys are completely absent. There are also no rudimentary kidney structures. The ureter at the same time can be developed almost normally or be absent altogether. Agenesis is a common developmental defect and occurs not only in humans, but also in those animals that normally have two kidneys.

There is no reliable evidence that agenesis is a hereditary disease that is transmitted from parents to child. Quite often, the cause of this disease is multisystem malformations due to exogenous influences during the embryonic stage of fetal development.

Along with agenesis, other defects of the genitourinary system are often found, provided that there is a complete absence of the ureter and vas deferens on the same side. Often, along with agenesis, malformations of the female genital organs, which have a general underdevelopment, are also found in females. The urinary system and the female reproductive system develop from different rudiments, so the simultaneous appearance of these defects is irregular. From all of the above, there is reason to believe that renal agenesis is a congenital, and not a hereditary, defect, and is a consequence of exogenous influences in the first six weeks of fetal development. A risk factor for the development of agenesis includes mothers with diabetes mellitus.

Types of renal agenesis:

Bilateral renal agenesis

This defect belongs to the third clinical type. Newborns with this defect are mostly born dead. However, there were cases when a child was born alive and full-term, but died in the first days of his life due to kidney failure.

Today, progress does not stand still, and it is technically possible to transplant a kidney into a newborn and perform hemodialysis. It is very important to timely differentiate bilateral renal agenesis from other defects of the urinary tract and kidneys.

Unilateral renal agenesis

Unilateral renal agenesis with preservation of the ureter

This defect belongs to the first clinical type and is congenital. With unilateral aplasia, the entire load is taken on by a single kidney, which in turn is often hyperplastic. An increase in the number of structural elements allows the kidney to take on the functions of two normal kidneys. The risk of severe consequences if one kidney is injured increases.

Unilateral renal agenesis with absence of the ureter

This defect manifests itself at the earliest stages of embryonic development of the urinary system. A sign of this disease is the absence of the ureteric orifice. Due to the structural features of the male body, renal agenesis in men is combined with the absence of a duct that removes seminal fluid and changes in the seminal vesicles. This leads to: pain in the groin area, sacrum; painful ejaculation, and sometimes to sexual dysfunction.

Treatment of renal agenesis

The method of kidney treatment depends on the degree of kidney dysfunction. The most commonly used surgical intervention is kidney transplantation. Along with surgical methods, there is also antibacterial therapy.

Kidney duplication

According to sectional statistics, it occurs in 1 case in 150 autopsies; in women 2 times more often than in men. It can be unilateral (89%) or bilateral (11%).

Causes of kidney duplication:

Kidney duplication occurs when two foci of induction of differentiation are formed in the metanephrogenic blastema. In this case, two pyelocaliceal systems are formed, but complete separation of the blastemas does not occur, and therefore the kidney is covered with a common fibrous capsule. Each half of the doubled kidney has its own blood supply. The renal vessels can depart separately from the aorta, or they can arise through a common trunk, dividing at the renal sinus or nearby. Some intrarenal arteries pass from one half to the other, which can be of great importance during partial nephrectomy.

Symptoms of kidney duplication

Most often the upper half is underdeveloped; very rarely both halves are functionally the same or the lower half is underdeveloped. The underdeveloped half in its morphological structure resembles kidney dysplasia. The presence of parenchymal renal dysplasia in combination with urodynamic disturbances due to splitting of the ureter creates the preconditions for the occurrence of diseases in the abnormal kidney. Most often, the symptoms of kidney duplication duplicate the symptoms of the following diseases: chronic (53.3%) and acute (19.8%) pyelonephritis, urolithiasis (30.8%), hydronephrosis of one half (19.7%). Kidney duplication can be suspected by ultrasound, especially with dilatation of the upper urinary tract.

Diagnosis of kidney duplication

Excretory urography helps diagnose kidney duplication. However, the most difficult task is determining complete or incomplete doubling. The use of magnetic resonance urography and MSCT greatly simplifies this problem, but does not solve it completely. The presence of a ureterocele is a factor that complicates the diagnosis of complete or incomplete renal duplication. Cystoscopy in the vast majority of cases helps establish the diagnosis.<#"justify">Dystopia

Dystopia is the location of an organ, tissue or individual cells in an unusual place for them, caused by dysembryogenesis, trauma or surgery.

Heterolateral cross kidney dystopia (d. renis heterolateralis cruciata) is a congenital kidney dystopia with its location on the opposite side, next to the second kidney.

Homolateral kidney dystopia (d.renis homolateralis) is a congenital kidney dystopia with its location above or below normal.

Dystopia of the kidney thoracic (d. renis thoracica) - D. kidney with congenital diaphragmatic hernia with its location in the chest cavity subpleurally.

Dystopia of the ileal kidney (d. renis iliaca) is a homolateral D. of the kidney with its location in the large pelvis.

Lumbar kidney dystopia (d.renis lumbalis) is a homolateral kidney dystopia with its location in the lumbar region below normal.

Pelvic kidney dystopia (d. renis pelvina) is a homolateral kidney with its location in the small pelvis.

Literature

Markosyan A.A. Questions of age-related physiology. - M.: Education, 1974

Sapin M.R. - HUMAN ANATOMY AND PHYSIOLOGY with age-related characteristics of the child’s body. - publishing center "Academy" 2005

Petrishina O.L. - Anatomy, physiology and hygiene of children of primary school age. - M.: Education, 1979

N.V. Krylova, T.M. Soboleva Genitourinary apparatus, anatomy in diagrams and drawings, publishing house of the Peoples' Friendship University of Russia, Moscow, 1994.

Guide to urology, edited by N. A. Lopatkin, Medicine Publishing House, Moscow, 1998. Download the essay "Human Urinary System" in full for free

A. G. Khripkova, V. S. Mironov, I. N. Shepilo Human Physiology, Prosveshchenie Publishing House, Moscow, 1971.

R. D. Sinelnikov Atlas of Human Anatomy, Medicine Publishing House, Moscow, 1973.

A. V. Kraev Human Anatomy, Medicine Publishing House, Moscow, 1978.

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