What are the drugs for ureteral dilation

As the name suggests, ureteral dilatation means that the ureter is larger than normal. This is only a symptom. When ureteral dilatation occurs, the specific cause must be identified first. There are two types of ureteral dilatation: congenital and acquired. The congenital ones include megaureter, and the acquired ones are mainly caused by some ureteral tumors or ureteral stones blocking the ureter, resulting in local enlargement of the ureter. Some mild ureteral dilatation does not have any symptoms and is easily ignored. What are the drugs for ureteral dilatation?

Ureteral dilatation can be classified into obstructive, reflux, and non-obstructive non-reflux according to etiology. Generally, there are no specific clinical manifestations. Most patients seek medical treatment with low back pain and bloating as the main complaints. Occasionally, patients seek medical treatment for waist and abdominal masses, hematuria, persistent urinary tract infection, and renal insufficiency. Patients with mild ureteral dilatation are often asymptomatic and are discovered during physical examinations or examinations for other diseases. Treatment should focus on finding the primary disease causing ureteral dilatation, treating the cause, symptomatic treatment and surgical treatment.

Diagnosis and differential diagnosis

The grading criteria for ureteral dilatation in neonates developed by the Society of Fetal Urology (SFU) are also applicable to adults. Ureteral dilatation is divided into grades 0 to 4 according to the degree of dilatation of the upper urinary tract. Grade 0: no separation of the central collecting system of the kidney; Grade 1: mild separation of the renal collecting system; Grade 2: dilation of the renal pelvis but no dilation of the renal calyx; Grade 3: significant separation of the renal pelvis and the same degree of dilation of the renal calyx, but normal thickness of the renal parenchyma; Grade 4: on the basis of Grade 3, the thickness of the renal parenchyma becomes thinner. The differential diagnosis process of ureteral dilatation is the diagnostic process.

1. Ureteral tumor

Common benign lesions of ureteral tumors are ureteral polyps, and malignant lesions are ureteral cancer. Unlike ureteral tuberculosis, which causes ureteral dilatation, hydronephrosis and renal dysfunction above the lesion, ureteral tumors are characterized by patients presenting with painless hematuria. Excretory and retrograde urography showed filling defects at the ureteral lesions, dilation of the ureter above the lesions, and smooth mucosa. Unlike ureteral tuberculosis, the lesions were not extensive and showed worm-eaten or beaded changes. The ureter may become S-shaped due to hydrops, but there is no sign of stiffness. The urine exfoliated cells test may be positive. Pathological diagnosis can usually be obtained by taking a biopsy tissue through ureteroscopy.

2. Ureteral inflammatory stenosis

It is caused by nonspecific infection, often secondary to pyelonephritis and cystitis. Excretory and retrograde urography shows localized stenosis of the ureteral inflammation site, ureteral dilatation and hydronephrosis above the stenosis, which should be differentiated. However, there were no destructive changes in the renal pelvis and calyces. Urine culture was positive for bacteria but negative for Mycobacterium tuberculosis. Cystoscopy showed edema and congestion of the bladder mucosa, but no tuberculous nodules, granulation wounds or ulcers. Its clinical manifestations are characteristic of ureteritis, with paroxysmal colic occurring due to ureteral peristalsis. The main clinical manifestations of ureteral tuberculosis are frequent urination, urgency and pain when urinating, which are different from each other.

3. Ureteritis

The cause of periureteritis is unknown. The lesion occurs as proliferation of retroperitoneal fibrous tissue, which surrounds one or both ureters. It is commonly found at the ureteropelvic junction and the iliac vessel bifurcation. But it can also affect the ureters above the pelvis and even the kidneys. Because fibrous tissue surrounds the ureter, it causes ureteral stenosis, ureteral rigidity, and hydronephrosis, which need to be differentiated. Periureteritis is rare and is rarely associated with frequent urination, urgency, and pain. Excretory and retrograde urography show that the ureter is displaced toward the midline and the lumen is narrowed, but the ureteral lumen is smooth without worm-eaten or beaded changes, and there are no destructive lesions in the kidney. Cystoscopy showed no tuberculous nodules, granulation wounds or ulcers on the bladder mucosa. Urine examination showed few pus cells and no rice-soup pyuria.