It is a 25-30 cm long hose-like organ that allows urine flow from the kidneys to the bladder (urinary bladder). It allows urine to reach the bladder by making peristaltic (wave motion) movements with the straight and circular muscle fibers in its structure. These peristaltic movements are the reason for the intermittent aggravation of pain in patients passing stones.
Ureters have three anatomical stenosis areas. These fields are important for patients passing stones because of the stone getting stuck.
Ureter diseases are strictures, stones and tumors. Ureteral tumors are examined together with kidney tumors and surgery is performed together with the kidneys. Although ureteral strictures are generally congenital, they can also be iatrogenic due to ureteral surgeries that are frequently performed today. Especially during colon (large intestine) and gynecological operations, due to its close proximity to these organs and its thin structure, it may be injured or tied with sutures as a result of not being noticed.
Ureteral Stones
Ureters carry the urine produced by the kidney to the bladder. is important for. However, if the ureter is blocked by a falling stone, it may result in severe pain and, in the future, kidney loss due to the pressure exerted by the urine produced. When ureteral stones completely block the duct, the kidney will continue to produce urine first, causing urine accumulation, kidney enlargement due to high pressure, and severe pain. Due to the peristaltic movement of the ureter, increases in pain intensity occur from time to time (colic pain).
Ureter Surgery
In the later period, the kidney Pain can be relieved by stopping urine production and reducing pressure through various mechanisms. During this period, patients who think that they have passed the stone due to the relief of pain and do not come for a check-up may experience irreversible damage to the kidneys or even kidney loss. It should not be forgotten that the kidney is not an organ that can renew itself.
Treatment of Ureteral Stones
Treatment of ureteral stones varies depending on the region and the size of the stone. The diameter of the ureter decreases to 5 mm in the lower part. For this reason, stones under 5 mm are congenital in the patient. If there is no anatomical stenosis, it usually disappears with medical treatment. Stones between 5-10 mm in diameter have an average of 30-50% chance of passing spontaneously with medical treatment. Most of these patients require additional treatments or surgery (ESWL or URS operation).
Stones larger than 1 cm in diameter have a 1% chance of passing on their own. In addition to the size of the stones, the ureteral segment in which they are located is also important in the treatment plan. While the ESWL method is first tried for stones in the upper part, the priority is in favor of surgery for stones in the lower part. The reason for this is that the success of ESWL is lower in the lower part of the stones due to various reasons, and since the stone can be easily accessed by operation, the first option is in favor of the operation. In the upper section, both ESWL success is higher and it is not always possible to reach the upper section with URS. Another reason is that as the stone progresses through the ureter with URS, it may escape into the kidney due to the effect of water and pressure. In this case, the stone cannot be reached.
URS
This is the name given to the operation of imaging the ureter with the help of an optical camera. It is performed with semirigid and the recently popular flexbl URS devices. Semirigid URS: It is the process of reaching the urinary bladder by entering through the urinary canal with a slightly flexible metal optic, and finding the ureter orifice with the help of a wire called sensor guide and ascending from there to the kidney. During this time, structures such as stones and tumors observed in the ureter can be intervened.
Flexbl URS: Since it is a foldable instrument, its use has increased in recent years because it can pass the ureter folds easily and follow the stones that escape to the kidney. increasing. (roughly, it can be given as an example of a thinner and miniature version of the device used in stomach endoscopy.)
Small stones in the kidney can also be treated with this device (RIRS method). Although it is considered a very useful method because all stones can be easily accessed, stones cannot be removed with this method because the working channel is small. The stones are broken into very small pieces with a laser device and left to fall on their own. Since laser breaking in large stones will take a long time, its use is restricted. In addition, due to the thin structure of the tool, it can malfunction very quickly. Therefore, the image quality is worse than semirigid URS. Its use is currently limited because the device is expensive, the equipment it uses is expensive, it is difficult to use, and it malfunctions very quickly.
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