The first description of the ureterocele belongs to Lechler and refers to 1834. This anomaly was discovered during the autopsy, but Lechler considered it to be double bladder.

In 1961, Uson, Lattimer, Melich found that ureterocele often occurs when the kidneys are doubled.

A ureterocele may also be accompanied by ectopic ureteral orifice (an atypical location), duplication of the ureters, infection, and ureterocele stone formation.

When doubling the top urinary tract ureterocele in most cases is detected in the ureter of the upper half.

This pathology is detected at any age and accounts for 1-2% of cases of the total population.

Ureterocele in men is less common than in women (1:2-2.5).

Ureterocele in children occurs with a frequency of 1:500 newborns.

Forms

Pathology can be both congenital and acquired.

Depending on the location of the ureterocele, there may be:

• intravesical (protrusion is localized in the cavity of the bladder and has many options);
• extravesical (occurs when the ureter flows into the genitals, urethra or paraurethral).

Although the generally accepted classification of ureterocele has not yet been developed, there are:

• Simple (orthotopic) ureterocele, which can be unilateral or bilateral. Expansion of the ureter with this type of ureterocele is observed directly in the bladder. In most cases, it is small in size, but can be combined with compression of the adjacent ureter in the presence of its doubling or with compression of the contralateral ureter.
• Ectopic ureterocele, which is accompanied by the penetration of part of the ureter into the urethra or into the neck of the bladder. It occurs at a low level of ectopia of the ureteral orifice, is large in size and can compress the orifices of the contralateral and main ureters.

Depending on the degree of development of the pathology, there are:

• I degree, in which the intravesical ureter is slightly expanded, and there are no functional changes in the renal cavity system;
• II degree, in which the expansion of the ureter leads to the accumulation of urine and the development of ureterohydronephrosis;
• III degree, in which, in addition to ureterohydronephrosis, there are significant dysfunctions of the bladder.

Reasons for development

The cause of ureterocele can be:

• Congenital anomaly of the structure distal ureter (deficiency of muscle fibers in the area included in the wall of the bladder), which leads to lengthening of the intramural segment, or congenital narrowing of the mouth of the ureter.
• Blockage of the mouth of the ureter (occurs during the formation of kidney stones and their migration into the ureter, etc.).

If the structure of the wall layers in the lower part of the ureter is disturbed and its opening is narrowed, the pressure in the ureter increases, and the ureter wall is stretched.

The resulting expansion, wedged between the layers of the bladder wall, exfoliates its wall and forms a cavity that contains urine.

The ureterocele increases at regular intervals when filled with urine, and decreases when urine is ejected through the orifice of the ureter.

Pathogenesis

An increase in hydrostatic pressure in the ureter and overstretching of its wall leads to its bulging into the intravesical section of the bladder.

The ureterocele may be small in size and manifest only as frequent urination, but with a significant size, the ureterocele protrudes into the ureter and obstructs the outflow of urine from one of the kidneys.

When the volume of the ureter is limited, frequent urination with a small amount of urine is observed.

With a significant size of the ureterocele in women and girls, there may be a noticeable descent of the protrusion into the urethra, even from the outside. In such cases, acute or chronic urinary retention develops.

In case of violation of the process of urination in the renal pelvis, stagnation of urine (hydronephrosis) occurs, infection with microbes occurs and cystitis and pyelonephritis develop. These processes contribute to the formation of urinary stones, and subsequently lead to nephrosclerosis and the loss of kidney function.

In any variant of the pathology, the Weigert-Meyer law is not violated - when the ureter is doubled, the orifice of the ureter of the upper pelvis is located in the bladder medially and below the orifice of the ureter of the lower pelvis.

With duplication of the ureters, many combinations of different variants of this protrusion and ectopia of the mouths of the ureters are revealed, but with a high ectopia of the mouth of the ureter, the ureterocele is never localized in the main ureter.

With an ectopic ureterocele, a low ectopia of the orifice of the ureter is always detected, and the intramural ureter is absent.

A simple ureterocele is localized in the corner of the vesical triangle (in the place of the normal location of the ureteral orifice), and the intramural section is preserved.

Symptoms

A ureterocele is often asymptomatic until pyelonephritis develops. The development of this complication is accompanied by:

• an increase in body temperature;
• change in color and transparency of urine (becomes cloudy and dark, up to a shade of "meat slops");
• pain in lumbar region accompanied by a feeling of fullness in the side.

Often with ureterocele infectious diseases urinary system, there is frequent urination and imperative (sudden and irresistible) urge to urinate.

Pus may be present in the urine, and in some cases, blood.

With a large size of the protrusion and its descent into the urethra, urinary incontinence is observed. In women, this prolapse can lead to complete urinary retention.

With a total violation of the outflow of urine from the kidneys and the development of acute hydronephrosis, there are paroxysmal pains similar to renal colic.

Diagnostics

In most cases, a ureterocele is detected during the examination due to recurrent urinary tract infections.

A general urinalysis in this pathology reveals the presence of leukocytes, erythrocytes and pus, and bacteriological examination allows us to detect the microflora that is characteristic of urinary infections.

Conducted ultrasound of the bladder allows you to detect a rounded thin-walled liquid formation protruding on the wall of the bladder. Ultrasound of the kidneys in most cases reveals unilateral or bilateral hydronephrotic transformation of the organ.

Cystography gives a clear x-ray picture of the ureterocele. Radiographs can reveal vesicoureteral reflux into the adjacent and opposite ureter, the presence of a defect in the filling of the bladder and club-shaped expansion of the distal ureter (sometimes ectopia is detected).

To determine the degree of violation of the outflow of urine, excretory urography is used, in which a contrast agent is injected into a vein.

Uroflowmetry measures the rate of urine flow during urination.

The mouths of the ureters and the mucous membrane of the bladder are examined in detail using cystoscopy, for which a special optical device is inserted through the urethra.

Treatment

Since mechanical obstruction of the ureter often occurs with this pathology, removal of the ureterocele is performed to eliminate the blockage.

To remove the orthotopic variant of the protrusion, transvesical excision was used for a long time, which was combined with antireflux surgery, however, with small and medium-sized protrusions, endoscopic removal of the ureterocele is now preferred.

Endoscopic removal is performed using electroincision, endosurgical scissors or a holmium laser. The operation includes two stages - first, the wall of the ureterocele is dissected and, in the presence of a stone, ureterolithotripsy is performed, and then the reconstructive-plastic stage of the operation is performed.

With large protrusions and ectopic protrusions, endoscopic surgery does not justify itself, therefore, ureterocystoanastomosis (artificial connection of the ureter with the bladder) according to Politano-Leadbetter is used.

Surgical methods of treatment are accompanied by the use of uroantiseptic and etiotropic antibiotic therapy.

For the treatment of pyelonephritis, drugs of the fluoroquinolone group are often used.

In case of duplication of the ureter and in case of atrophy of part of the parenchyma of the kidney, the affected part is removed (resection), and in case of complete atrophy of the kidney, it is removed.

Prevention

Prevention of the development of complications includes:

• timely treatment for difficult urination;
• treatment of bladder diseases with antibacterial drugs;
• following a diet that includes limited intake of salt, protein and fatty foods.

The female urethra (urethra) is surrounded by a large number of glands, called paraurethral, ​​or Skinian, after the American gynecologist Skene, who first described them in detail. It has been established that these groin-shaped glands are similar in structure to the prostate in men. Multiple ducts and sinuses form an extensive network of tubular canals that surround the female urethra, mainly along the posterior and lateral walls. Usually, the ducts of the glands empty into the lower third of the urethra. The secret of the paraurethral glands protects the urethra from the penetration of pathogens and plays a barrier role during sexual contact.
The paraurethral glands undergo significant changes at different periods of a woman's life: during pregnancy, they reach their maximum size, in postpartum period undergo involution, in climacteric - atrophy. In this regard, paraurethral cysts are more common in women of a fairly young age.
A paraurethral cyst is formed due to blockage of the duct of one or more paraurethral glands. Most common causes are inflammatory process and instrumental interventions on the urethra. A paraurethral cyst may also form as a result of a birth or surgical injury caused during an episiotomy (perineal incision) or surgical intervention on the urethra.
Symptoms of a paraurethral cyst
The symptoms that paraurethral cysts manifest themselves in are largely nonspecific and resemble other urological diseases. In many ways, the symptoms depend on the phase of development of the cyst. In the early stages, when the paraurethral gland is initially infected, urination disorders predominate: pain, frequent urination, and the presence of discharge from the urethra.
Later, when chronic inflammation develops around the cyst, pelvic pain may join, as well as pain associated with sexual contact. At this stage of cyst development, there may be such clinical symptoms, like an admixture of pus in the urine, sensation foreign body in the urethra, induration of the paraurethral zone and its hypersensitivity. Paraurethral cysts can also be asymptomatic. In this case, they are detected during a preventive examination by a gynecologist.
What is the danger of having a paraurethral cyst?
Obviously, paraurethral cysts are an excellent reservoir in which stagnant urine can accumulate along with the secretion of the gland and infection can develop.
With inflammation of the cysts, abscesses occur, which often open into the urethra, followed by the formation of urethral diverticula. The presence of hematuria (blood in the urine) in the absence of evidence of a lower urinary tract infection may indicate the presence of a stone or tumor within the cystic mass. Due to chronic traumatization of the urethral mucosa, hyperplastic and neoplastic changes may occur within the cyst. Rarely within the paraurethral cystic formations a malignant neoplasm develops - carcinoma, which is the subject of quite a large number of publications.
Diagnosis of a paraurethral cyst
To detect a cyst, it is enough to pass the following surveys: examination in the gynecological chair, general analysis urine, bacteriological culture of urine. May need cytological examination urine in patients with an unclear diagnosis, when a tissue component is found in the cavity, or in the presence of blood in the urine.
Paraurethral cysts are often mistaken for other diseases, as a result of which inadequate treatment is carried out, which does not give a positive result. In this regard, paraurethral cysts must be distinguished from diseases such as urethral diverticulum, tumors of the anterior vaginal wall, urethro- and cystocele, vaginal cysts. In case of difficulties with the diagnosis, it is necessary to use the most modern methods examinations such as ultrasound procedure(ultrasound), magnetic resonance imaging (MRI), video urethrocystoscopy.
Ultrasound for the diagnosis of paraurethral cysts can be performed using transabdominal, endovaginal, transperineal, and transrectal techniques. The relative simplicity, non-invasiveness, and low cost of this imaging modality are potential advantages of ultrasound. All ultrasound methods of examination are devoid of radiation exposure and are associated with a much lower risk of infectious complications than diagnostic procedures that require bladder catheterization.
In some cases, with the help of ultrasound, it is possible to visualize the anastomosis between the cystic cavity and the urethra. Besides, this method research can be used to differentiate solid and cystic paraurethral formations, identify stones in the lumen of the latter, and also detect a possible tumor process inside the cyst. The use of Doppler scanning in the process of performing ultrasound makes it possible to detect atypical blood flow in the periurethral zone and the paraurethral formations themselves in cases of a tumor lesion.
Recently, in the world literature, there are more and more reports on the use of MRI in differential diagnosis paraurethral cystic formations. MRI is also a highly sensitive method for diagnosing paraurethral cysts and urethral diverticula. The use of a contrast agent during the study allows you to more clearly assess the architectonics of tissues. MRI can help in the differential diagnosis of cystic and solid formations, determine the presence of a tumor process and its stage, which is especially important for surgical treatment sick.
Treatment of a paraurethral cyst
In most cases, the treatment of paraurethral cysts is surgical. Preference should be given to techniques aimed at complete excision of the cyst walls. Various punctures, the use of laser exposure and electrocoagulation are unacceptable, because. they do not eliminate the disease completely and lead only to temporary relief of the patient's condition. In the end, there is still a need for an operation, the implementation of which will be hampered by the presence of a cicatricial process around the cyst.
Treatment of recurrent urinary tract infections with the use of adequate antibiotic therapy can be used both as a preoperative preparation and in patients who cannot be operated on or do not want surgical treatment for one reason or another.
Like any surgical intervention, excision of a paraurethral cyst can lead to a number of complications, such as recurrence of the cyst, the formation of urethro-vaginal and vesico-vaginal fistulas, urethral strictures, urethral pain syndrome, urinary incontinence, recurrent urinary infection, bleeding and hematoma formation.
Surgical assistance in the area of ​​the female urethra should be trusted only to those specialists who are engaged in such a practice constantly, and not periodically, since the accumulated experience in performing this kind of intervention significantly reduces the risk of complications.

A paraurethral cyst occurs as a result of blockage of the glands of the same name located near the urethra. The code for this disease of the genitourinary system of women according to International classification diseases - D 30.7.

The etiology of the disease is as follows. The paraurethral glands (or Skene's glands, named after the scientist who first discovered and described them) are located in the area where the urethra exits and produce a substance that moisturizes the urethra.

The same secret does not allow pathogenic bacteria to enter the urethra, being a kind of protective barrier. There are quite a lot of these glands at the mouth of the canal. For the reasons listed below, the exit of the gland may become clogged, and then the contents accumulate in it, forming a phenomenon such as a paraurethral cyst (ICD code 10 - D 30.7).

This disease is considered a purely female ailment, and a cyst is diagnosed in women of childbearing age. The incidence rate is low - from 2 to 8%. In general, the state of the glands directly depends on the stage of a woman's life.

During pregnancy, Skene's glands increase, after childbirth they decrease, and menopause generally leads to atrophy of the glands. This condition is often acquired, very rarely congenital.

A paraurethral cyst is a round seal, small in size and rather elastic to the touch, which is located at the surface of the skin, near the exit of the urethra, rarely in deeper layers of tissues.

It is felt from the side of the vagina. If an infection joins, then the contents of the cyst may be purulent.

There are several varieties of this neoplasm:

1. Skinian cysts. These are directly cysts resulting from blockage of the paraurethral glands.
2. Cyst of Gartner's passage. It is a consequence of an anomaly in the development of the genitourinary system due to the fusion of the germinal ducts and the walls of the vagina and urethra. Here the secret accumulates and a cyst appears.

Causes and signs

Why might such a state arise? The reasons that lead to the development of the disease:

• inflammation of the urethra;
• trauma;
• rough sex;
• complications after childbirth;
• decreased immunity;
• common diseases, such as diabetes;
• sexually transmitted diseases;
• the use of certain intimate hygiene products.

On the initial stages the development of the disease, a woman, as a rule, is concerned about urination disorders. Then comes the pain and discomfort. In general, the symptoms of this disease are very vague, individual for each specific case and are similar to the signs of many other diseases. female organs. It can be:

• feeling of discomfort when walking, sexual intercourse;
• swelling in the area of ​​the urethra;
• pain and pain when emptying the bladder;
• admixture of blood in the urine;
• pus or mucus that is discharged from the urethra;
• urinary incontinence;
• false urge to urinate;
• a feeling of fullness and the presence of a foreign body in the urethra.

Complications of a disease such as a paraurethral cyst include the formation of urethral diverticula and malignant degeneration of the cyst, which, fortunately, is extremely rare.

Diagnosis and treatment

A paraurethral cyst is diagnosed, which refers to diseases of the genitourinary system (code according to the International Classification of Diseases - D 30.7), based on such studies:

1. History taking: what diseases were transferred when complaints appeared?
2. Vaginal examination. It allows you to determine the localization and size of the cyst.
3. General urine analysis. In this case, the number of leukocytes, erythrocytes is determined, which indicates the presence of inflammation in the pelvic organs.
4. Urine culture, which allows to identify the causative agent of inflammation.
5. A smear from the urethra. It makes it possible to determine the presence of inflammation in it.
6. Ultrasound of the pelvic organs, which is performed transvaginally. This study shows the location and size of the neoplasm.
7. Urethrocystoscopy is a study in which a special optical device is inserted into the urethra, which allows you to visually assess the condition of the urinary tract mucosa. This study is rarely done.

The only cure is surgical removal of the paraurethral cyst. This operation consists in excision of its walls. Other methods of treatment (for example, laser) will not solve the problem completely, but only briefly alleviate the patient's condition.

Medical methods of treatment, as a rule, do not give the desired result, although in some cases they can help. It all depends on the reasons that caused the paraurethral cyst.

Women who have had such a neoplasm removed can perfectly endure and give birth to a child.

Among possible complications after removal of the cyst may be:

• cyst recurrence;
• narrowing of the urethra;
• hematomas;
• fistulas;
• bleeding.

Preventive measures to be taken to avoid the occurrence of the disease:

1. Careful personal hygiene.
2. Wearing cotton underwear.
3. Pregnancy planning and treatment of all inflammatory diseases of the urogenital area before it occurs.
4. Strengthening immunity.

Paraurethral cyst (code - D 30.7) is a rather unpleasant disease that brings great inconvenience to a woman. Therefore, at the first signs, you should consult a doctor to clarify the diagnosis and prescribe the appropriate treatment.

In 8% of women, a disease such as a paraurethral cyst is noted. The treatment of this pathology is mainly surgical, but conservative methods also apply. Symptoms occur only when the cyst reaches a certain size, until that moment it may not make itself felt at all.

What is a paraurethral cyst?

A paraurethral cyst is understood as a surgical pathology in which a rounded saccular cavity with liquid contents is formed at the mouth or elsewhere in the urethra. ICD-10 disease code - D.30.7.

The source of secretion accumulation in the cyst is Skene's glands, or paraurethral glands. They are located next to the external opening of the urinary canal - on the front wall of the vagina. The purpose of these organs, as well as a number of other glands, is to secrete a special secret that does not allow the urethral mucosa to dry out. Under certain circumstances, the mouths of the glands narrow or close completely, the gland overflows with a secret - a cyst appears.

This disease is characteristic only for women, it does not occur in men. Sick, for the most part, girls and women of reproductive age.

In pregnant women, Skene's glands increase in size, after childbirth they return to their previous size. Other hormonal changes can also affect the growth of the glands, and in menopause they partially atrophy. Therefore, in women after 50-55 years, the cyst is almost never diagnosed.

Externally, a paraurethral cyst can be like this:

• Uncomplicated cyst - rounded, elastic, soft, without signs of redness, mucous fluid is released when pressed;
• A complicated cyst is a painful, inflamed formation from which pus is released.

Kinds

There are two types of paraurethral cysts. It:

1. Cysts of Gartner's passage. More often they are congenital, due to a violation of the structure of this anatomical zone - the fusion of the vaginal wall with the urethra.
2. Skinian cysts. Formed around the urethra, associated with a violation of the outflow of secretion of the glands.

In the photo, the formation of a paraurethral cyst in women

Causes

Cysts that appear in a girl from birth are rare. Much more often, formations are caused by trauma to the zone or an inflammatory process with:

• Acute and chronic urethritis;
• Abuse of soap-based hygiene products;
• A sharp decrease in immune defense;
• STD;
• Traumatic childbirth with perineal dissection, ruptures, suturing;
• Rough sexual contact;
• Unsuccessful fall, hitting the frame of a bicycle.

Cysts develop in stages. The first stage is usually ignored - it does not show any symptoms. The gland becomes damaged or inflamed, causing blockage of its mouth. It is possible to identify such a cyst only during an examination for other indications. In the second stage, the cyst grows in size, begins to give clinical signs, causing the need to visit a specialist.

The mechanism for the appearance of a cyst is as follows:

• Obstruction of the duct of Skene's gland;
• Violation of the outflow of the secret;
• Formation of a cyst;
• Inflammation and suppuration of education;
• Without treatment - rupture of the cyst wall, the appearance of a diverticulum of the urethra.

Symptoms

A small, non-suppurating cyst has no symptoms. But as she grows, the woman begins to complain of pain, discomfort during intercourse, discomfort when walking, a feeling of fullness.

Other possible symptoms:

• Visually noticeable swelling in the area of ​​​​the entrance to the urethra;
• Excretion of urine in small portions, drop by drop;
• Burning during urination, sometimes - pain and cutting, as in acute urethritis;
• Discharge with pus (there is a small amount of purulent impurities), with trauma to the area - the appearance of a small volume of blood from the urethra;
• Urinary incontinence.

With suppuration of the cyst, general signs of inflammation can also be observed - the body temperature rises, the head hurts, malaise, weakness are felt.

Diagnostics

Usually the patient turns to the urologist or gynecologist when the education already has big sizes, it is very rare to find early stage. But at a planned urological or gynecological examination, the doctor will notice the formation - it protrudes at the entrance to the urethra. With a deeper location, which is rare, diagnosis without the use of instrumental techniques will be difficult.

• ureteroscopy;
• Ultrasound through the vaginal access.

Education should be differentiated from the cyst of the vagina, tumors and diverticula. To exclude inflammation, a general blood test, urine test, urine test for bakposev are taken.

Paraurethral cyst on MRI

How is it treated

It is impossible to completely get rid of education without surgery. But the treatment will still be complex, because there is an inflammatory process in the urethra. Opening a cyst without its complete removal is usually not practiced - this will give a temporary effect, because the shell remains in place. Only with severe suppuration and the impossibility of performing an operation, the cyst is immediately pierced with a needle, the pus is pumped out, and antibacterial treatment is prescribed.

Conservative therapy

If a conservative tactic is chosen at the initial stage of treatment, the contents of the cyst are pumped out and therapy for the infectious process is prescribed. A woman takes antibiotics (Ofloxacin, Norfloxacin and others) for 7-14 days. Antibacterial therapy prescribed before surgery to prevent complications. Usually, after pumping out the contents of the cyst, its excision is planned for 25-30 days, since a conservative procedure increases the risk of rupture of the formation.

Operation

Under local or general anesthesia, the cyst is removed. This method is the most reliable, after which the risk of relapse is minimal. When the cyst is located in the far parts of the urethra, it is necessary to do a laparoscopic operation, but usually such interventions are required only when a diverticulum or abscess has formed.

The hospital stay after surgery is 5 to 7 days. A catheter will be in the urethral cavity for 2 days. In the rehabilitation period, you will have to abandon intimate life for 1.5-2 months. For the same period, physical activity is excluded.

Possible complications after surgery sometimes include:

• Narrowing of the urethra due to the appearance of adhesions;;
• Pain syndrome
• Reappearance of a cyst;
• Fistula formation;
• bleeding;
• Inflammatory process.

Predictions and possible complications

Without removal, the cyst will fester sooner or later, because it will not resolve on its own. In addition to the appearance of an abscess (abscess), such a development of events threatens the appearance of a chronic recurrent infection -,. With timely excision of the formation, the prognosis is favorable.
On the video about the causes, symptoms and treatment of urethral cysts in women: