Ureteral valves

　　First, etiology

　　The etiology of congenital ureteral valve disease is unclear. Although there are 3 theories of pathogenesis, it seems that the 'residual fetal fold theory' can better explain the formation of annular valves and multiple annular valves in the upper ureter, while the 'membrane formation theory' can explain the formation of lower ureteral valves. As for the 'abnormal ureteral embryogenesis theory', it can explain the occurrence of other different types of ureteral valves.

　　Second, pathogenesis

　　The embryonic development mechanism of ureteral valves is still unclear, and there are 3 theories.

　　1. Persistent presence of the Chwalle membrane causes: The Chwalle membrane is an epithelial tissue membrane located in the lumen of the lower end of the ureter, which appears at 6 weeks of pregnancy as a normal sign of ureteral development. However, it will rupture and regress at 8 weeks. If it only partially ruptures or does not rupture, it will lead to the formation of a ureteral valve.

　　2. Pathological obstruction caused by physiological folding.

　　3. Abnormal ureteral embryogenesis.

　　1. Horseshoe kidney:The upper or lower poles of both kidneys fuse to form a horseshoe kidney, with an incidence of 1/500 to 1000 and a male-to-female ratio of 4:1. Horseshoe kidney occurs in the early embryonic stage, resulting from the fusion of the two renal embryos between the umbilical arteries due to tight squeezing.

　　2. Repetitive renal and ureteral malformations:It is a common congenital malformation of the urinary system. Replicated kidneys and ureters can be unilateral or bilateral. Unilateral is more common than bilateral, with the right side four times more common than the left, and females are more common than males. The incidence varies among different statistics.

　　3. Poor renal rotation.

　　Commonly presented as pain in the flank and abdomen on the affected side, nausea, vomiting, urinary tract infection symptoms; in the case of bilateral lesions, renal insufficiency may occur; hematuria is often present during colic and stones; a mass with a cystic sensation can be palpated in the flank and abdomen in cases of hydronephrosis.

　　Wall and Wachter proposed the characteristics of the ureteral valve from an anatomical perspective and used it as the basis for diagnosis:

　　1, The ureteral mucosa has transverse folds, containing smooth muscle fiber bundles.

　　2, The ureter above the valve is dilated, and the ureter below is normal.

　　3, There are no other mechanical or functional obstruction factors.

　　This disease is a congenital disease, the clinical etiology is unclear, and it is related to autosomal recessive inheritance, usually related to marriage between close relatives, and this disease cannot be prevented directly. Patients with a suspected family history of chromosomal abnormalities should undergo genetic screening to avoid offspring with the disease due to chromosomal inheritance after marriage. At the same time, attention should be paid to strengthening prenatal nutrition, rational diet, and avoiding adverse stimuli that affect embryo development, such as emotional excitement.

　　1, Urinalysis shows red blood cells and pus cells in the urine of patients with concurrent infection and stones.

　　2, When renal insufficiency occurs, blood biochemical tests show increased blood urea nitrogen and creatinine.

　　The typical X-ray manifestations of intravenous urography (IVU) and retrograde pyelography (RGP) are as follows: ① The ureteral lumen is parallel to the renal pelvis wall, forming a 'high-position embedded obstruction'; ② A conical or lobular filling defect is produced on one side of the ureteral wall and embedded in the narrowed ureteral lumen; ③ Each side of the ureteral wall opposite to each other has a filling defect embedded in the lumen, forming a pair of interlocked flaps, and the reversed imaging shows an inverted 'V' shape change at the lesion site.

　　First, food therapy formula

　　1, Shen Sanqi glutinous rice porridge:Shen Sanqi powder 3 grams, fried yellow glutinous rice 30 grams, a little rock sugar. Cook glutinous rice into porridge, add a little rock sugar, and swallow Shen Sanqi powder.

　　2, Baimaogen porridge:Baimaogen 30 grams, fried yellow glutinous rice 30 grams, a little rock sugar. Boil Baimaogen in water to get the juice, add glutinous rice to cook porridge, add a spoon of rock sugar, and eat it warm.

　　3, Jineijing yam porridge:Jineijing 9 grams, yam 60 grams, brown sugar 2 spoons. Grind Jineijing into powder and cook it with yam to make porridge, add brown sugar, mix well, and eat at will.

　　4, Shiwei yam porridge:Shiwei 30 grams, yam 90 grams, brown sugar to taste. Boil Shiwei in water to get a bowl of juice, mix it with 3 bowls of yam porridge, and add brown sugar to serve.

　　5, Yam porridge:Huangshan山药60-100 grams, Fuling 30 grams, Xiaojin 10-15 grams, rice 100 grams. First, cook Huangshan山药, Fuling, and Xiaojin, then take the juice and cook it with rice to make porridge.

　　6, Sea cucumber porridge:Sea cucumber 50 grams, rice 100 grams. Soak the sea cucumber, wash it, slice it, cook it until it is soft, and then cook it with rice to make porridge.

　　Secondly, patients should eat

　　1, The daily water intake should be 2000-3000 milliliters, and it should be increased to 4000-5000 milliliters in hot summer, and it should be increased after sweating, at least maintaining a daily urine output of more than 2000 milliliters.

　　2, You can drink magnetized water, which is easy to dissolve kidney stones.

　　3, Increase the intake of foods rich in vitamin A, such as pork liver, eggs, as well as fresh cabbage and fruits.

　　4, Suitable foods: Walnut, corn silk, kiwi, Shouxin, yellow croaker brain, red bean, chicken stew, fragrant vinegar vegetables, yellow sprouts, winter melon, kudzu, watermelon, loofah, pear, cucumber, seaweed, lotus root, carrot, eggplant, bamboo shoots, sweet potato, pumpkin, mung bean, snail,螺视, frog meat, etc.

　　三、患者忌食用

　　Three, patients should avoid eating1. Eat less calcium-rich food:

　　For example, kelp, black fungus, beans, amaranth, milk, celery, nori, sea eel, pickled radish, pumpkin seeds, dried red dates, etc.2. Eat less oxalate-rich food:

　　For example, spinach, celery, cocoa, coffee, beetroot, strawberry, orange, sweet potato, black tea, etc.3. Eat less food that can easily increase uric acid, cystine, and xanthine:

　　Conventional Western treatment methods for ureteral valves

　　The main purpose of the treatment is to remove the valve, and the choice of surgical method and approach should be determined according to the degree of obstruction and the health condition of the child. For mild to moderate obstruction with mild azotemia, transurethral electrocoagulation of the valve can be selected, which is effective. A few patients can destroy the valve and dilate the urethra by inserting a catheter, cystoscope, or perineal incision and inserting a urethral probe.

　　Children with severe hydronephrosis should be given antibiotics, indwelling catheters, and treatment to correct and balance electrolytes, as well as urinary sepsis and azotemia. Children with vesicoureteral reflux and renal dysplasia should undergo bladder stent surgery.

　　Most severe hydronephrosis children, because of the dilatation and relaxation of the ureter, the hypertrophy of the bladder trigone area, leading to the obstruction of the ureterovesical junction, the single bladder stent and valve resection is not satisfactory. For these patients, ureterocutaneous stent is needed to achieve the protection of renal function and reduce or eliminate hydronephrosis. After the function of hydronephrosis is improved, valve resection and ureteral reconstruction surgery should be performed.

　　After the obstruction is relieved, antibiotics should be used to prevent the recurrence of urinary sepsis and urinary tract infection. The time of urinary tract diversion should be as short as possible, as long-term bladder and upper urinary tract diversion can cause permanent bladder contraction. Johnston (1979) reported that about 50% of children with urethral valves have vesicoureteral reflux, and the prognosis of bilateral reflux is often very poor. After the obstruction is relieved, 1/3 of the patients can naturally disappear, and 2/3 of the patients need surgical treatment for reflux.