Duplicated pelvis and ureteral malformation

　　Pathologically, it is caused by the early embryonic stage when two ureteric buds enter one metanephric primordium.

　　In the early fifth week, a small blind duct is emitted to the dorsal side of the head at the end of the mesonephric duct where it enters the cloaca. The ureteric bud rapidly extends in the cranial and dorsal direction of the embryo and grows into the mesodermal tissue of the renal cord at the tail of the embryo. The ureteric bud elongates and gradually evolves into the ureter, with its distal end extending towards the head, repeatedly branching to over 12 levels, with the initial two levels expanding and merging to form the renal pelvis, the third and fourth levels expanding and merging to form the renal calyces, and the rest evolving into collecting ducts. When the ureteric bud head forms a cystic dilatation, the tail end tissue of the metanephric cord is induced by the ureteric bud to differentiate into postnatal metanephric primordium, also known as postnatal renal tissue.

　　I. Abnormal opening of the ureter:The ureter normally opens into the trigone of the bladder.

　　II. Ureteral orifice cyst:It is a congenital cystic dilatation at the lower end of the ureter, which bulges into the bladder or posterior urethra.

　　Three, Congenital巨 ureter is also known as functional obstruction at the end of the ureter, and is different from secondary ureteral dilation.

　　Four, Ureteral stenosis

　　1, There are congenital and secondary types, the former has it from birth and becomes worse with age. Stenosis is often located at the junction of the ureteral origin and renal pelvis; or at the junction of the end and bladder. The latter is often caused by infection, tuberculosis, or tumor.

　　2, Ureteral stenosis and poor urine flow lead to reactive dilation of the ureter, which eventually results in renal hydrops.

　　The duplicated part often locates at the upper pole, which does not require special treatment. If the duplicated ureter opens outside the bladder, it is called ectopic ureteral orifice, which is more common in females. The manifestation depends on the location of the ectopic orifice. Ectopic orifice in males is more common in the posterior urethra and seminal vesicle, and in females, it is more common in the urethra, vestibule, and vagina. The typical manifestation in females is both spontaneous urination and persistent dribbling or urinary incontinence.

　　1, The sleeping posture after the operation should be correct, it is best to turn your head to one side to prevent vomiting. There will be a low fever on the day after the operation, so you should pay attention.

　　2, Do a good job of observing and ensuring the patency of the drainage tube, and pay attention to whether the ureter is placed in the correct position.

　　3, Prevent bacterial infection at the surgical wound, avoid water contact when taking a shower, and use iodophor solution to clean the urethral orifice regularly, then drink more water.

　　4, Observe your urination more closely in the days before the ureter is removed, and be careful not to hurt the wound when removing the ureter.

　　One, Urinary tract imaging:The shadowed lower renal pelvis is similar to the normal renal pelvis, but the number of calyces is reduced and the position is lower. The upper renal pelvis is often atrophic and shrunken or like a cyst. In addition, renal pelvis hydrops can also be shown. This malformation has various types, and its X-ray manifestations are as follows.

　　1, There is a duplicated renal pelvis but only a single ureter.

　　2, The renal pelvis and part of the ureter are duplicated.

　　3, The renal pelvis and ureter are all duplicated, and can be accompanied by ectopic ureteral orifice, or one end is a blind pouch.

　　4, There is a single renal pelvis but with duplicated ureter, one end of the duplicated ureter can be a blind pouch.

　　Two, Ultrasound manifestations:Generally, it can only show the duplicated kidney, in addition to the increase in renal long diameter, it can be seen that the light spots of the strong echo collection system are obviously divided into two groups. However, the duplicated ureter is not clearly shown by ultrasound unless it is combined with hydrops and dilation.

　　Three, CT manifestations:It shows that one kidney has two sets of renal pelvis and ureteral systems, the upper renal pelvis is often underdeveloped and inward. The lower renal pelvis is normally developed with calyces and is located lower and outward. The combination of duplicated kidney and upper renal pelvis and ureteral dilation and hydrops is common in ectopic ureteral orifice, and the upper renal pelvis's draining ureter can be seen to be fully dilated to the pelvis, and the lower end does not enter the bladder. However, CT cannot clearly indicate the orifice location.

　　Four, MR manifestations:The coronal view can more clearly show the duplicated pelvis and ureteral malformation. In addition to the longer length of the duplicated kidney, when the upper renal segment expands into a cyst due to hydrops, the expanded draining ureteral segment can also be partially visible, and it can be seen that the lower renal segment is displaced outward due to pressure from the hydropic renal pelvis.

　　1. It is advisable to eat light and easily digestible foods, avoid seafood, beef, mutton, spicy and irritating foods, alcohol, and all kinds of heat-inducing foods such as five-spice powder, coffee, coriander, etc.; especially for patients with yin deficiency, such as red tongue, surging pulse, night sweats, dry stools, hematuria, etc.; but for patients with yang deficiency, such as pale tongue with white fur, deep pulse, cold limbs, loose stools, they can eat warm foods.

　　2. It is advisable to eat fresh vegetables and moderate amounts of fruit, drink adequate water; avoid all tonics, herbal remedies, and hot foods that are easy to cause heat, such as chili, lychee, chocolate, etc.; especially for patients with yin deficiency and internal heat, such as purple tongue, slow pulse, chest tightness, abdominal distension, and blood stasis.

　　3. All kidney patients are prohibited from using neomycin, streptomycin, gentamicin, rhizoma Atractylodis macrocephalae, and vaccines.

　　4. Uremic patients should maintain smooth defecation, and it is best to defecate 2 to 3 times a day. Avoid staying up late,节制 sexual activity, pay attention to rest, and avoid catching a cold.

　　5. Those who have taken hormones should gradually reduce the dosage and frequency under the guidance of a doctor according to their specific conditions.

　　6. Those with severe edema should avoid salt, limit the intake of protein-rich foods, and drink less water. Those with mild edema can consume low-sodium salt diet; those without edema should not limit the intake of water and protein-rich foods; those with microscopic hematuria and those prone to heat should drink more water and eat yin-nourishing and heat-reducing foods such as apples, white sugar, black sesame, and mushrooms.

　　7. Those with hyperkalemia due to uremia should avoid eating high-potassium foods such as bananas, oranges, potatoes, tomatoes, pumpkins, tea, soy sauce, monosodium glutamate; while patients with low blood potassium levels should do the opposite.

　　8. Those with high uric acid levels should especially avoid eating animal internal organs, fish, shrimp, crabs, clams, beer, mushrooms, beans, and spinach.

　　9. During treatment, if symptoms such as cold, fever, infection, etc. occur, contact the doctor of this department in an emergency to receive timely treatment and avoid the aggravation of complications.

　　10. Build confidence, persist in treatment, and maintain a cheerful mood.

　　Treatment of Duplicated Pelviureteral Anomalies

　　The treatment of duplicated pelviureteral anomalies is determined according to the presence or absence of duplicated pelvis and the function of the corresponding renal parenchyma. If there is hydronephrosis, infection, or poor function in the duplicated pelvis, perform surgery on the duplicated kidney. If there are no such manifestations and the function is still good, perform anastomosis of the affected ureter to the lower pelvis or the end-to-side anastomosis of the ureteral bladder. Timely surgical treatment is the key to the treatment of duplicated pelviureteral anomalies.