What shows the ultrasound of the kidneys, the norm and decoding. Hardware and laboratory methods for diagnosing kidney stones Kidney stones what ultrasound to do

It is difficult, and therefore the patient suffers not only from pain, but also from uncertainty. You can read the results of the study on your own, only if you have a good understanding of medical terms and norms.

The kidneys in the human body perform an important job. The blood, passing through this organ, is cleansed, and harmful substances are excreted from the body along with urine. Blood and plasma pass through the Shumlyansky-Bowman capsule and are separated into blood and primary urine. With the further passage of fluid through the body of the kidney, some of the nutrients are again mixed with the blood and carried throughout the body, and all filtered substances, such as creatine and uric acid, enter the ureters and are excreted from the human body. In just a day, all the blood in the body passes through the kidneys up to 100 times, and up to 150 liters of primary urine and only about one and a half liters of secondary urine are formed from it.

There are usually two kidneys in the body.

They are located symmetrically at the posterior abdominal wall, closer to the lumbar region, and the right kidney is usually 1-2 cm lower than the left one.

The normal size of the organ is up to 12 cm in length and up to 6 in width, and the standard weight does not exceed 200 grams. But in the presence of pathologies or congenital features of the human physique, the size of the organs can change. Whether the size is a pathology or a variant of the norm - only a doctor can say after examining the whole organism.

Kidney diseases are treated by nephrologists. A therapist (or pediatrician) can refer a patient to them if the patient complains of discomfort during urination, back pain, or if surgery is needed in the body, for example, a kidney transplant.

What are the indications for ultrasound diagnosis of the kidneys:

• Renal failure, acute and chronic;
• Suspicion of the presence of stones or sand in the kidneys;
• Injuries and bruises of the organ;
• Tumors, cysts and swelling of the kidneys;
• The presence of gas in the kidneys;
• Pathological changes in the ureters and urinary tract, bladder;
• Successfully performed transplant or preparation for it.

In addition, if the content of creatine, erythrocytes, uric acid or other substances is increased in the patient's urine, then the doctor has reason to suspect a hidden inflammatory process, pyelonephritis, and undiagnosed diseases of the kidneys and urinary tract. They often occur secretly in the patient's body, and are considered grounds for additional diagnostic procedures that will identify the disease.

How is a kidney ultrasound performed?

Ultrasound of the kidneys can often be difficult due to the position of this organ.

Since ultrasound freely passes through soft tissues, but is scattered in the air and does not penetrate bones, it is possible to examine the kidneys in detail only from one side.

In order for the study to be accurate, it is necessary to carefully prepare for it. First of all, before an ultrasound of the kidneys, you should not eat foods that cause gas formation, since ultrasound will not penetrate through the gas-filled intestines and the diagnosis will be uninformative.

You can not eat cabbage, legumes, black bread, drink beer and carbonated drinks before an ultrasound. The diet is recommended to be followed for three days. If the patient suffers from constipation, then it is recommended that he cleanse the intestines, take a laxative or make an enema before starting the study.

During the diagnosis, the patient lies on the couch, on his back. The laboratory assistant applies the gel to the skin for better glide of the transducer and removal of air. A transducer that receives reflected ultrasound moves across the skin of the abdomen, resulting in an accurate black-and-white image of the kidney in front of the doctor. It is forbidden to perform an ultrasound while standing, as the incorrect position of the patient may affect the accuracy of the diagnosis and not show the results. The only option in which ultrasound can be performed while standing is the poor health of the patient, who cannot lie down.

Similarly, diagnosis is carried out when the patient turns on his back, on the right and left sides.

What does a kidney ultrasound show?

Ultrasound diagnostics is considered one of the most accurate research methods that currently exist, and therefore if pathological changes are detected on ultrasound, then with a high degree of probability it can be argued that the diagnosis is correct. But only a doctor can identify pathological changes in the system and explain their nature.

What ultrasound shows:

Kidney sizes. This is one of the first parameters that the doctor and laboratory assistant pay attention to. The standard sizes are as follows:

• 100-200mm length;
• 50-60mm width;
• 30-50mm thickness;
• The thickness of the outer tissue, parenchyma - up to 25 mm;
• Capsule size - up to 1.5 mm;
• The total weight of one organ is up to 200 grams.

If the size of the kidneys is outside the normal range, then the doctor can diagnose a tumor, tissue hypoplasia, or identify another pathology. Most often, the kidneys increase in the presence of inflammatory processes, and the decrease in tissues is associated with the age of the patient, and usually the parenchymal layer decreases.

In the parenchyma, tumors and cysts most often occur. Due to its structure, this tissue is looser, softer, subject to changes, including pathological ones. There may also be an opposite effect: if one kidney was removed, then the parenchymal tissue of the other will develop twice as much.

What is the structure of kidney tissues?

In the normal state, the parenchyma is heterogeneous, and lighter and darker areas are visible on ultrasound. This is due to the structure of the parenchymal tissue itself, which acts as a filter for impurities contained in the blood. The parenchyma consists of pyramids, the inner parts of the tissue adjacent to the renal calyces, and the outer layer, which is displayed on ultrasound as a less dense, light tissue.

If pathological changes are present in the organ system, then the parenchymal tissue will be altered, enlarged, or heterogeneous in whole or in part. The structure of the tissue is also related to the fact that cysts and tumors occur most often in this part of the organ, and during ultrasound diagnostics, the state of the parenchyma can reveal the first changes, signs and symptoms of the disease.

The outlines of the kidneys themselves should be even, clear. The blurred border, which was revealed on ultrasound, signals the development of inflammation in the tissues, and requires additional diagnostics.

The internal structure of the kidneys

The pelvicalyceal apparatus, which is responsible for the accumulation and elimination of harmful substances from the human body. It is here that secondary urine accumulates, which will soon be excreted from the body through the ureters and bladder.

The calyces are responsible for the accumulation of urine. There can be up to 10 of them inside one organ, 4-6 small and 3-4 large. Large cups adjoin the pelvis, cavities where urine accumulates. When the pelvis is partially filled, the muscle fibers surrounding the kidney contract, and the accumulated urine is excreted into the bladder through the ureter.

When conducting ultrasound diagnostics, the doctor examines the internal cavities especially carefully. Most often, when diagnosing, they distinguish:

• Urolithiasis, that is, improper functioning of the body, due to which salts are deposited in the kidneys, forming stones and sand. This pathology is dangerous because the stone blocks the exit of urine to the ureter, and excess fluid compresses the parenchymal tissue, which atrophies from prolonged compression. In addition, urolithiasis gives the patient a lot of anxiety and discomfort;
• The development of tumors and cysts, which can also compress tissues and blood vessels, and disrupt the functioning of individual parts of the kidney or the organ as a whole;
• Narrowing or curvature of the ureter, which leads to urinary retention and malfunction of the entire system. This pathology leads to stagnation of fluid in the pelvis and the accumulation of harmful substances in the body.

The ureter itself is examined no less carefully. It may look like a tube less than 1 cm in diameter and up to 30 cm long on the monitor screen. It is hollow inside, which means that this organ will appear on ultrasound as a tube with light walls and a dark middle. If the ureter is clogged, for example, with urolithiasis, when a stone comes out, then a bright spot will be noticeable during ultrasound diagnostics.

One of the most frequent diseases of the kidneys and urinary system is pyelonephritis. This disease is characterized by persistent pain in the lumbar region, high body temperature of the patient, painful urination, and an increase in white blood cells in the analysis of blood and urine. There are other similar signs by which a doctor can make a diagnosis, but ultrasound will be one of the main methods for diagnosing this disease.

The term "pyelonephritis" most often refers to any inflammatory diseases of the kidneys and bladder. But, strictly speaking, pyelonephritis is an inflammation caused by bacteria and affecting the pelvis, calyx or parenchyma. During the ultrasound, an increase or change in the echogenicity of these organs can be detected, and based on the results of the ultrasound diagnosis and blood tests, the doctor can prescribe treatment.

When the ultrasound diagnosis is completed, the patient receives his medical record with the results of the examination and tests. According to the analysis, the nephrologist will be able to make the most accurate diagnosis and prescribe the most suitable treatment for the patient. A blood and urine test should be done before a kidney ultrasound for more accurate results.

It is equally important to conduct an ultrasound of the kidneys during pregnancy, if the woman had problems with them before. Since at the time when a woman is carrying a child, her body weight and blood volume increase, and the load on the body is increased, the kidneys suffer from this in the first place. In addition, during the third trimester, all organs are compressed, which reduces the volume of the kidneys. The doctor, in the presence of complaints, usually directs the woman to an appointment with a nephrologist and an ultrasound scan, prescribes a diet, which allows you to notice the disease in time or simply reduce the load on the kidneys.

Regular examination of the kidneys and urinary system allows early detection of pathological changes, showing the onset of the disease and explaining its cause. With regular examination and monitoring of your health, even a serious disease can be detected and cured at an early stage.

- this is a manifestation of urolithiasis, characterized by the formation of salt stones (stones) in the kidneys. Accompanied by aching pain in the lower back, bouts of renal colic, hematuria, pyuria. Diagnosis requires CT and ultrasound of the kidneys, excretory urography, radioisotope nephroscintigraphy, and the study of biochemical parameters of urine and blood. Treatment of nephrolithiasis may include conservative therapy aimed at dissolving stones, or their surgical removal (nephrolithotripsy, pyelolithotomy, nephrolithotomy,).

General information

Kidney stones (renal stones, nephrolithiasis) are a common pathology. Specialists in the field of practical urology quite often encounter nephrolithiasis, and stones can form in both children and adults. Males predominate among patients; stones are more often detected in the right kidney, in 15% of cases bilateral localization of stones occurs.

Acquired disorders of salt metabolism can be due to external (exogenous) and internal (endogenous) causes. Among the external factors, the greatest importance is given to climatic conditions and the drinking regime and diet. It is known that in hot climates with increased sweating and a certain degree of dehydration of the body, the concentration of salts in the urine increases, which leads to the formation of kidney stones. Dehydration of the body can be caused by poisoning or an infectious disease that occurs with vomiting and diarrhea.

In the northern regions, the factors of stone formation can be a deficiency of vitamins A and D, a lack of ultraviolet radiation, the predominance of fish and meat in the diet. The use of drinking water with a high content of lime salts, food addiction to spicy, sour, salty also leads to alkalization or acidification of urine and precipitation from salts.

Among the internal factors, hyperfunction of the parathyroid glands is distinguished - hyperparathyroidism. The increased work of the parathyroid glands increases the content of phosphates in the urine and the leaching of calcium from the bone tissue. Similar disorders of mineral metabolism can occur with osteoporosis, osteomyelitis, bone fractures, spinal injuries, spinal cord injuries. Endogenous factors also include diseases of the gastrointestinal tract - gastritis, peptic ulcer, colitis, leading to acid-base imbalance, increased excretion of calcium salts, weakening of the barrier functions of the liver and changes in the composition of urine.

Pathogenesis

The formation of kidney stones occurs as a result of a complex physicochemical process in violation of the colloidal balance and changes in the renal parenchyma. A well-known role belongs to unfavorable local conditions in the urinary tract - infections (pyelonephritis, nephrotuberculosis, cystitis, urethritis), prostatitis, kidney anomalies, hydronephrosis, prostate adenoma, diverticulitis and other pathological processes that disrupt the passage of urine.

Slowing down the outflow of urine from the kidney causes stagnation in the pyelocaliceal system, oversaturation of urine with various salts and their precipitation, delay in the excretion of sand and microliths with urine. In turn, the infectious process developing against the background of urostasis leads to the ingress of inflammatory substrates into the urine - bacteria, mucus, pus, protein. These substances are involved in the formation of the primary nucleus of the future calculus, around which salts crystallize, which are present in excess in the urine.

From a group of molecules, a so-called elementary cell is formed - a micelle, which serves as the initial core of the stone. The “building” material for the nucleus can be amorphous sediments, fibrin threads, bacteria, cellular detritus, foreign bodies present in the urine. The further development of the process of stone formation depends on the concentration and ratio of salts in the urine, the pH of the urine, the qualitative and quantitative composition of the urinary colloids.

Most often, stone formation begins in the renal papillae. Initially, microliths form inside the collecting ducts, most of which do not stay in the kidneys and are freely washed out by urine. When the chemical properties of urine change (high concentration, pH shift, etc.), crystallization processes occur, leading to retention of microliths in the tubules and encrustation of papillae. In the future, the stone may continue to "grow" in the kidney or descend into the urinary tract.

Classification

According to the chemical composition, there are several types of stones found in the kidneys:

• Oxalates. Composed of calcium salts of oxalic acid. They have a dense structure, black-gray color, prickly uneven surface. They can form in both acidic and alkaline urine.
• Phosphates. Calculi consisting of calcium salts of phosphoric acid. By consistency, they are soft, crumbling, with a smooth or slightly rough surface, whitish-grayish in color. They form with alkaline urine, grow quite quickly, especially in the presence of infection (pyelonephritis).
• Urats. Represented by crystals of salts of uric acid. Their structure is dense, the color is from light yellow to brick red, the surface is smooth or finely punctate. Occurs with acidic urine.
• Carbonates. Calculi are formed during the precipitation of calcium salts of carbonic (carbonate) acid. They are soft, light, smooth, can have a different shape.
• cystine stones. The composition contains sulfur compounds of the amino acid cystine. Calculi have a softish consistency, smooth surface, rounded shape, yellowish-white color.
• Protein stones. Formed mainly by fibrin with an admixture of bacteria and salts. The structure is soft, flat, small in size, white in color.
• cholesterol stones. Rarely seen; formed from cholesterol, have a soft crumbling texture, black color.

Sometimes in the kidneys, stones are formed not of a homogeneous, but of a mixed composition. One of the most difficult options are coral stones, which make up 3-5% of all stones. Coral-like calculi grow in the pelvis and in appearance represent its cast, almost completely repeating the size and shape of the organ.

Symptoms of nephrolithiasis

Depending on their size, number and composition, kidney stones can cause symptoms of varying severity. A typical clinic includes lower back pain, the development of renal colic, hematuria, pyuria, and sometimes independent excretion of a stone from the kidney with urine. Pain in the lower back develops as a result of a violation of the outflow of urine, can be aching, dull, and with an abrupt onset of urostasis, with blockage of the pelvis of the kidney or ureter by a stone, progress to renal colic. Coral-like stones are usually accompanied by a dull dull pain, while small and dense ones give a sharp paroxysmal pain.

A typical attack of renal colic is accompanied by sudden sharp pains in the lumbar region, spreading along the ureter to the perineum and genitals. Reflexively, against the background of renal colic, frequent painful urination, nausea and vomiting, and flatulence occur. The patient is agitated, restless, cannot find a posture that alleviates the condition. The pain attack in renal colic is so pronounced that it is often stopped only by the introduction of narcotic drugs. With obstruction by stones in both ureters, postrenal anuria and fever develop.

At the end of the attack, kidney stones often pass with urine, post-pain hematuria is possible. The intensity of hematuria can be different - from slight erythrocyturia to severe gross hematuria. The excretion of pus in the urine (pyuria) develops with inflammation in the kidneys and urinary tract. The presence of kidney stones is not symptomatic in 13-15% of patients.

Diagnostics

Recognition of kidney stones is made on the basis of anamnesis, a typical picture of renal colic, laboratory and instrumental imaging studies. At the height of renal colic, a sharp pain is determined on the side of the affected kidney, a positive symptom of Pasternatsky, pain on palpation of the corresponding kidney and ureter. To confirm nephrolithiasis is performed:

• Laboratory diagnostics. Urinalysis after an attack reveals the presence of fresh red blood cells, white blood cells, protein, salts, bacteria. Biochemical examination of urine and blood to a certain extent allows us to judge the composition and causes of the formation of stones.
• ultrasound. With the help of ultrasound of the kidneys, anatomical changes in the organ, the presence, localization and movement of stones are evaluated. Right-sided renal colic must be differentiated from appendicitis, acute cholecystitis, and therefore it may be necessary to perform abdominal ultrasound.
• X-ray diagnostics. Most of the calculi are already determined during survey urography. However, protein and uric acid (urate) stones do not reflect X-rays and do not give shadows on survey urograms. They are subject to detection using excretory urography and pyelography. In addition, excretory urography provides information on morphological and functional changes in the kidneys and urinary tract, localization of stones (pelvis, calyx, ureter), shape and size of stones.
• CT scan of the kidneys. Computed tomography is the "gold standard" of diagnostics, since it allows you to see stones of any size and density. If necessary, the urological examination is supplemented by radioisotope nephroscintigraphy.

Treatment of kidney stones

Conservative treatment

Treatment of nephrolithiasis can be conservative or operative and in all cases is aimed at removing stones from the kidneys, eliminating infection and preventing re-formation of stones. With small kidney stones (up to 3 mm), which can be removed independently, an abundant water load and a diet that excludes meat and offal is prescribed.

With urate stones, a milk-vegetable diet is recommended, alkalizing urine, alkaline mineral waters (Borjomi, Essentuki); with phosphate stones - taking acidic mineral waters (Kislovodsk, Zheleznovodsk, Truskavets), etc. Additionally, under the supervision of a urologist, drugs that dissolve kidney stones (for example, citrate therapy for urate stones) can be used.

First aid for renal colic

With the development of renal colic, therapeutic measures are aimed at relieving obstruction and pain attack. For this purpose, injections of platifillin, metamizole sodium, morphine or combined analgesics in combination with atropine solution are used; a warm sitz bath is performed, a heating pad is applied to the lumbar region. With non-stopping renal colic, a novocaine blockade of the spermatic cord (in men) or a round ligament of the uterus (in women), ureteral catheterization is required.

Surgery

Operative removal of stones is indicated for frequent renal colic, secondary pyelonephritis, large calculi, ureteral strictures, hydronephrosis, blockade of the kidney, threatening hematuria, single kidney stones, staghorn stones. With nephrolithiasis, remote lithotripsy is used, which allows you to avoid any intervention in the body and remove fragments of calculi through the urinary tract. With stones up to 2 cm in diameter, you can use the method of "flexible retrograde nephrolithotripsy", as well as percutaneous nephrolitholapaxy, which allows you to remove the stone through a puncture in the kidney.

Open or laparoscopic interventions for the extraction of stones - pyelolithotomy (dissection of the pelvis) and nephrolithotomy (dissection of the parenchyma) are rarely resorted to, mainly when minimally invasive surgery is ineffective. With a complicated course of nephrolithiasis and loss of kidney function, nephrectomy is indicated. After removal of stones, patients are recommended spa treatment, life-long diet, elimination of concomitant risk factors.

Forecast and prevention

In most cases, the course of nephrolithiasis is prognostically favorable. After the removal of stones, subject to the instructions of the urologist, the disease may not recur. In adverse cases, calculous pyelonephritis, symptomatic hypertension, chronic renal failure, hydropyonephrosis may develop.

For all types of kidney stones, it is recommended to increase the volume of drinking up to 2 liters per day; the use of special herbal preparations; exclusion of spicy, smoked and fatty foods, alcohol; exclusion of hypothermia; improvement of urodynamics through moderate physical activity and exercise. Prevention of complications of nephrolithiasis is reduced to the early removal of stones from the kidneys, the mandatory treatment of concomitant infections.

• Complaints
• Tactics for renal colic
• Diagnostics
• Radiation diagnostics
• Ultrasound of the kidneys
• Kidney scintigraphy
• Laboratory research
• Treatment and prevention

• Make an appointment

Urolithiasis is quite common. Its prevalence in developed countries is 1-5%, and the incidence among middle-aged men is 1% per year. The lifetime chance of urinary stones is 20% for men and 5-10% for women. In 50% of patients, a second stone forms within 5 years. The most common cause of stone formation is insufficient urine volume. Therefore, drinking plenty of water is the most important part of preventing recurrence of urolithiasis.

Complaints

Tactics for renal colic

Diagnostics

Radiation diagnostics

Ultrasound of the kidneys

CT

Kidney scintigraphy

Laboratory research

Treatment and prevention

2009-10-14 13:33:06

Alena asks:

I have kidney stones on ultrasound = 1 cm, I recently went out, phosphates were determined. But I am concerned about occasional back pain, slight weakness and inflammatory urinalysis. What will you advice me?

Responsible Chernikov Alexey Vitalievich:

Hello. It is very difficult to advise anything, having only the ultrasound data and your symptoms. Most likely there is pyelonephritis on the background of urolithiasis. I advise you to safely go to the doctor. Good and attentive. And remember that urolithiasis is not only a disease of the kidneys and urinary tract. This is a disease of the whole organism due to metabolic disorders, and only partially - the urinary system. Therefore, an appropriate approach is required. You will need to reconsider all your bad habits and diet. As a reward, you can count on a full active life.

2016-09-27 19:08:37

Valeria asks:

Hello! .After some time, I began to feel like a needle in my bladder, I especially felt it when I lay down on my stomach. I went to the therapist, he sent me for an ultrasound of the bladder and for urinalysis. No. The last couple of days I feel pain when urinating. Help, what could it be?

2016-06-13 12:11:16

Oleg asks:

A year ago, a stone was removed from the kidney (it went out on its own, it got stuck in the ureter, they did ureteroscopy). But from that moment on, there are constantly dull pains in the right lower side from the back, just above the waist. I feel normal, there is no temperature, and I have been in pain for a year now. Also recently there were pains in the right side below the ribs, at the same level as the old problem. What could all this be? Went for an ultrasound, they said there is sand, but nothing else. I will soon go to the urologist for an appointment, also an ultrasound and tests. What could it be?

Responsible Aksenov Pavel Valerievich:

Hello. I would advise you to visit a neurologist, such pains are more typical for neurological problems. According to ultrasound - the sand is not visible, but is visible only in the analysis of urine. This is so, for information.

2016-05-05 07:11:57

Irina asks:

Hello! In February, I had an attack, the pain was in the left and right side. I was admitted to the hospital with suspected kidney stones, but nothing was found. The pains remained mild, she did an ultrasound and found a 17 mm floating stone in the gallbladder. The doctor suggests me to do a planned laparoscopy. Is it worth it to do or you can get rid of the stone in some other way. Thanks in advance for your reply.

Answers:

Hello Irina! Laparoscopic surgery is the best treatment for gallstone disease. Of the other methods, ultrasonic grinding (crushing) of the stone is possible, but it is suitable for all types of stones and not for all patients. In addition, after the crushing of stones, complications are possible associated with the problematic removal of fragments of stones through the bile ducts (blockage of these tracts). Discuss this possibility of treatment with your doctor. Take care of your health!

2016-04-03 15:21:45

Vladimir asks:

58 years old man. For a long time - high blood pressure 144 - 180 over 90-110. No noise in the ears, darkening, no dizziness. The cardiogram is normal (the conclusion of 2 cardiologists), the lungs are normal (X-ray, conclusion). Tomography of the brain - no deviations (conclusion). Urine general, blood general - normal (tests passed conclusion) Sugar is normal (5.8) Symptoms - the patient feels well (in his words) nothing hurts, nothing disturbs. From observation - Steps became short, slow, slight pain in the lower back at the time of crouching, turning over to the side while lying. Inhibition - question - pause - answer. According to the patient - fog or dope in the head. General weakness of the body. Inability to get up independently from a lying position - to a sitting position. Pissing at night. does not feel the urge. During the day, he hears the urge to go to the toilet. Walks partly. Appetite is good. 4 hours of examinations, almost all doctors - did not reveal the cause of high pressure. Were not on the ultrasound of the kidneys, urinary prostate. The urologist and the surgeon did not examine. The patient before he got to the hospital - led a sedentary lifestyle, smoked infrequently, drank coffee once a day in the morning, constantly watching TV. He moved little, slept for a long time. There are no serious injuries, he underwent an operation to replace the lens, he has a kidney stone. Does not feel acute pain.

Responsible Zhosan Dmitry Alexandrovich:

Hello, I advise you to consult a neurologist about general malaise, get a conclusion from him. Concerning a stone in a kidney - observation of the urologist.

2015-12-22 11:59:41

Damir asks:

Hello, Ultrasound and urinalysis found that I have a prolapse of the right kidney, and kidney stones. Please tell me, is it possible to do weightlifting in the future? If yes, how can I achieve this as soon as possible? Thanks in advance!

Responsible Aksenov Pavel Valerievich:

Good afternoon. There is too little information to answer your question. Firstly, according to the ultrasound data, it is not entirely correct to make a diagnosis of "omission of the kidney" - nephroptosis. Such a diagnosis is made on the basis of X-ray diagnostics. Secondly, we need data on stones: sizes, location, etc. Having all the data, including laboratory parameters, we can recommend something.

2015-12-20 17:29:04

Elena asks:

Hello! A cyst was found on the right kidney, size: 28x16mm. At the same time, a 4-mm stone was found. Treatment was carried out. Ultrasound showed that there was no stone. I did not feel how the stone came out. The doctor said that it dissolved in the form of a gel and came out. Does it happen or not? Maybe he is somewhere because the temperature does not subside. Advise what to do next with both the cyst and the stone. Thank you in advance for your help.

Responsible Mazaeva Yulia Alexandrovna:

Hello, the cyst is harmless. A small stone (rather sand) could dissolve itself, or it could go into the ureter and it is not visible on ultrasound. Submit a urinalysis and undergo an excretory urography or CT scan of the kidneys and ureters.

2015-06-18 15:47:56

Vitaly asks:

Good afternoon. After walking (I noticed that after walking) blood began to appear in the urine (sometimes scarlet), I go to the toilet normally. Has addressed to the urologist, has appointed or nominated US. It showed hydronephrosis and a kidney stone. To find out what led to hydronephrosis, I underwent SCT with IV amplification. When leaving the pelvis, the narrowing of the ureter is about 8-10 mm. no foci of contrast accumulation were found anywhere. They said they need an operation, they started collecting money.
Please tell me what you can drink while I collect the money so that there is no inflammation from irritation inside the stone, and is there any reason for this blood in the urine, and why, having lived for 44 years, I just now encountered this, because the narrowing of the ureter and the appearance of hydronephrosis did not come in a month? Thank you.

Responsible Medical consultant of the portal "site":

Hello Vitaly! In preparation for surgery, you should follow a diet and take medications recommended by your doctor. If the doctor has not prescribed anything for you, contact him again and discuss the possibility of using the renal collection and Canephron to prevent the development of inflammation in the kidneys and urinary tract. As for the explanation for such a late onset of symptoms, the most likely reason for the active development of hydronephrosis and the clinical manifestation of the disease was the development of urolithiasis, which aggravated the changes. associated with congenital narrowing of the ureter. Take care of your health!

2015-05-21 20:38:19

Vitaly asks:

Good afternoon!
Such situation. My husband is 28 years old, height - 172 cm, weight - 62 kg. On one of the ultrasound scans in 2010, they found a stone in the kidney - 6 mm. Found and found - he did not give himself away. But in 2013 (3 years later!) I had an attack. Apparently, the stone went. Another ultrasound showed the same stone, but already 8 mm in size. What he took there, I do not remember. But, apparently, he got out safely. Because at the subsequent ultrasound in 2 months it was no longer there.
In February 2014, I decided to do a control ultrasound about the condition of the kidneys - and then a surprise - an adenoma of the right adrenal gland measuring 21 * 20 mm. Shock, fear and horror. A month later they did a CT scan. In the description: in the right adrenal gland, a rounded formation with a density of 4-7 units of H to 12 units of H is determined, with dimensions of 24 * 13 * 19 with clear, even contours. Conclusion: CT picture of the mass formation of the right adrenal gland (Myelolipoma).
With this conclusion, the husband went to the oncologist, who said to cut. Without analyzes and other labudistics. Cut and all.
We are doubting guys, so we decided to wait a little with the "cut". Have started to hand over analyzes which were advised by the endocrinologist.
The results of the analyzes in the same 2014:
February:
Glucose - 5.9 (norm: 4.1 - 5.9)
Creatinine - 79 (norm: 80 - 115)
Bilirubin total - 35.3 (norm: 5-21)
Direct bilirubin - 7.34 (norm: Serum iron - 5.1 (norm: 12.5-32.3)
C-reactive protein: 20.2 (norm: Cortisol in the blood - 703.9 (norm: 171-536)
Aldosterone in an upright position - 56.26 (norm: 40-310)

Metanephrine in plasma - 44.6 (normal: Lipid profile and atherogenic index - normal
Thyroid hormones are normal
March:
Metanephrine in plasma - 43.0 (norm: Cortisol in the blood - 707.9 (norm: 171-536)
Aldosterone in a horizontal position - 45.98 (norm: 10-160)
April:
Potassium, sodium, chlorine - normal
Cortisol in the blood - 691.1 (normal: 171-536) - figure at 8.00
Cortisol in the blood - 287.7 (normal: 171-536) - indicator at 12.00
Cortisol in the blood - 192.4 (normal: 171-536) - indicator at 15.30
With these tests, we again went to the endocrinologist, who did not really explain anything, but said that it was better to observe her for a year, since the operation was a serious event, especially to remove the adrenal gland, etc. We clung to this opportunity and decided to live this year in peace.
A year and three months later, that is, now in May 2015, the husband again went to the oncologist (with old conclusions and analyzes) and heard the already familiar “cut”. And they didn’t just tell him this, but they already gave him a referral for an operation (June 9, 2015) with the exact time of arrival. Without ultrasound, etc.
I don’t understand this, so I sent my husband for an ultrasound scan to see the dynamics of adenoma growth over the year.
In the description of ultrasound: in the right adrenal gland isoechoic formation 25.1 * 26.5 in size.
As I understand it, the adenoma has not changed much in a year, except perhaps just a little bit.
Tell me, please, how justified is the direction for resection of the adrenal gland in this case?
And a few more questions:
1) On CT, they put a formation called myelolipoma. According to articles on the Internet, it is clear that myelolipomas are non-hormone-dependent formations. However, the level of cortisol in the blood is elevated. It turns out that one excludes the other? Or not?
2) At the next consultation, the oncologist surgeon said a word - they say, if the adrenal gland is not removed now, it will in any case lead to dysfunction of the second. Is it so?
3) If, nevertheless, the adrenal gland is removed, then what is the prognosis for later life? How scary is that? How long do they live with it?
4) Will hormone replacement therapy be necessary?
5) Is it possible to rule out cancer now?
6) If it is removed, will diabetes mellitus type 2 develop (sugar is at the upper limit of the norm, but he gave it for the first time in his life)?
7) His blood pressure is like a textbook - always 120/80. There were no other complaints. If they hadn't found her, they wouldn't have known that something was wrong. It turns out that if there is no pronounced clinical picture, then everything seems to be not so bad or is it deceptive?
8) And there is some other question that I cannot formulate now. But maybe you will see something and comment.
My husband is afraid to have an operation, and I can’t even convey my condition - everything is shaking. I'm very afraid of losing him.
Thanks in advance for your replies!
God bless you!

Responsible Bolgov Mikhail Yurievich:

Slightly different analyzes are needed: Metanephrines and Cortisol in daily urine, as well as the Aldosterone-renin ratio. This is in order to determine the hormonal activity of the tumor (or to make sure that it is absent). As for "cutting", I can't please you with anything, there are no other methods of getting rid of tumors yet. But is it worth it, is it worth it now, is it possible endoscopically (which is much less traumatic) - this, of course, is only at a meeting and a detailed study of all the nuances.

Popular articles on the topic: kidney stones on ultrasound

Renal colic"> Renal colic"> Renal colic"> Syndromes and diseases in nephrology and urology requiring emergency care
Renal colic

Renal colic (RC) is one of the most severe and excruciating types of pain that requires prompt diagnosis and treatment. The risk of PC during life is 1-10%. The most common cause of PC is urolithiasis (UCD) in the form of stones ...

Complete collection and description: why does the ultrasound of the kidneys not show stones? and other information for human treatment.

When kidney stones are detected on ultrasound, priority is given to X-ray research methods - intravenous urography, computed tomography.

On ultrasound, a true kidney stone is represented by a hyperechoic structure followed by an acoustic track. Compacted fat of the renal sinus, blood clots (due to fibrin) can imitate a stone. But these structures usually do not produce an acoustic shadow behind them, since their density is lower than the density of the stone. But in some cases, the detection of a kidney stone on ultrasound is difficult.
As with any organ, kidney stones can be single or multiple. There are coral stones - these are stones that occupy the entire pyelocaliceal system of the kidney.

If a stone blocks the outflow of urine below the upper third of the ureter, then such a stone is unlikely to be detected on ultrasound. The ultrasound doctor will only describe the signs of a kidney block. Since the ureters are not visible on ultrasound. You can see only its upper part, in case of its expansion. If the ureter is visible on ultrasound, then it is already dilated. Depending on the level of the block in the kidney, you can find:

Calicoectasia or hydrocalicosis - expansion of the cups more than 5 mm. More often cups increase in groups.

Pyelectasis - expansion of the pelvis more than 15 mm.

Calicopyeloectasia - expansion of the calyx and pelvis.

Ureteropyelocalicectasia - expansion of the ureter, pelvis and calyces.

hydronephrosis- persistent progressive expansion of the entire pelvicalyceal system of the kidney.

Stages of hydronephrosis:

Stage 1 - persistent progressive expansion of the pelvis;

stage 2 - persistent progressive expansion of the pelvis and calyces with initial manifestations of atrophy of the kidney parenchyma;

Stage 3 - terminal. The transformation of the kidney into a fluid sac. hydronephrotic transformation.

A secondary-shrunken kidney is a kidney that has lost its functional activity. An ultrasound revealed a decrease in the size of the kidney, an uneven external contour, and a violation of the differentiation of the layers.

Ultrasound examination of the kidneys is of great help to the doctor in the diagnosis of many pathologies of the urinary system. As a rule, it is used primarily as a screening method for detecting kidney pathology, since it is widely available, harmless, and highly informative at the same time as it is carried out quickly.

Why is an ultrasound of the kidneys prescribed?

Ultrasound of the kidneys is prescribed when the doctor suspects that the patient has a pathology in them. This can be thought of when there are changes in laboratory tests of urine or blood, or complaints from the patient himself.

The structure of the kidney

Ultrasound examination of the kidneys is indicated for pain in the lumbar region, in the abdomen, with fever with an unknown cause, with trauma to the abdominal cavity, with the appearance of a palpable mass in the abdominal cavity, with urine staining red, with frequent or slow urination, no urine, with intractable standard treatment for high blood pressure, at the first suspicion of cancer or the search for metastases.

In addition, under the control of ultrasound, it is possible to carry out minimally invasive interventions, assess the condition of organs after surgical or drug treatment.

Training

No special preparation is required for an ultrasound of the kidneys in adults. Only with severe intestinal distension is it recommended that the patient follow a diet with a restriction of vegetable fiber, fresh dairy products and bread for three days before the study.

It is not recommended to conduct an ultrasound examination on the same day after a colonoscopy or bowel X-ray with barium contrast, because the temporary changes in the intestine after these procedures will prevent the doctor from reliably and unhinderedly examining the structure of the kidney parenchyma.

What diseases can be detected?

With echography in the organs, focal and diffuse changes can be detected. Focal changes are called such changes that capture a small area of ​​​​the organ, while the rest of the kidney remains unchanged. With diffuse changes, pathology captures the entire structure of the organ.

Of the focal changes, cysts are most often detected in the kidneys. They look like anechoic (completely black) rounded structures with even, distinct contours, resulting in an increase in the ultrasound signal. Only one cyst may be seen, but more often there are several in one or both kidneys. As a rule, simple cysts do not pose any danger and occur in many people after 40 years.

If all of the kidney tissue is replaced by multiple cysts from birth, the condition is called polycystic. Polycystic kidney disease is often combined with similar changes in the liver and pancreas.

Polycystic kidney disease

An abscess occurs as a result of acute inflammation and, on ultrasound, unlike a cyst, has fuzzy contours and more echogenic contents, represented by pus. Sometimes an abscess may appear hyperechoic at first.

Among the focal changes relatively often with ultrasound, you can see a benign formation of angiomyolipomas. It is a formation of a rounded shape of increased echogenicity with even, clear contours.

Angiomyolipomas of the kidneys

Among diffuse diseases of the kidneys, glomerulonephritis and pyelonephritis are most often found. They do not have unambiguous ultrasound criteria, but there are a number of signs that are most typical for these inflammatory diseases on ultrasound.

Acute glomerulonephritis leads to an increase in the size of the kidney with an increase in the thickness of the parenchyma over 20 mm. At the same time, an increase in the echogenicity of the parenchyma can be noted.

Glomerulonephritis of the kidney

With long-term chronic glomerulonephritis, the size of the affected organ, on the contrary, becomes smaller than normal, the cortico-medullary differentiation of the parenchyma decreases, the thickness of the parenchyma becomes less than 12 mm.

Often, with acute pyelonephritis, it is impossible to see any characteristic changes on ultrasound. The kidney is hypoechoic, edematous, the boundaries between the cortical and medulla are blurred.

Chronic pyelonephritis is a long-term destructive process, therefore, it leads to morphological changes in the kidney, which can be seen with ultrasound. In the terminal stage of pyelonephritis, a decrease in the size of the affected kidney, a hyperechoic halo of the renal parenchyma, and individual small cysts are revealed. Over time, there is a thinning of the cortex with retraction of the surface, associated with the formation of scars.

Ultrasound examination helps in the diagnosis of kidney tuberculosis. It begins with the defeat of the pyramids, in which cavities with liquid contents are formed. When the cavities break through, a deformed hollow space is formed, which has a characteristic appearance with excretory urography. Ultrasound reveals hollow spaces containing fluid and partially calcified. At the same time, there is a gradual destruction of the renal parenchyma and wrinkling of the entire organ.

Very often in the kidneys there is a violation of the outflow of urine, which can be shown by an ultrasound device. There are several stages of hydronephrosis:

1. Expansion of the renal pelvis, the kidney parenchyma is not changed.
2. Expansion of the pelvis and calyces, thinning of the parenchyma.
3. Cystic expansion of the pelvis and a narrow rim of the parenchyma.
4. The parenchyma is not completely visible, it does not function, the kidney is a "bag" with dilated cups.

Hydronephrosis of the kidney

The reasons for the violation of the outflow can be different: blockage of the ureter by a calculus, blood clot, compression by a tumor, a pregnant uterus, and others.

One of the most common reasons for referral for renal ultrasound is renal colic. With the help of echography, in most cases it is possible to reliably determine the presence of stones with a diameter of more than 2 mm in the kidneys and urinary tract. The stones look like bright hyperechoic structures that reflect ultrasonic rays well from themselves, and then give a clear acoustic shadow.

The diagnosis “Sand in the kidneys”, which is widespread in some clinics, is actually not ultrasound, since at present only those structures in the kidneys with a linear size of more than 2 mm can be physically seen with an ultrasound device. And we all know very well that the diameter of the grains of sand is less than 2 mm.

Spongy kidney on ultrasound

The spongy kidney is a developmental anomaly - a congenital expansion of the structural components - the collecting ducts. For most patients, this anomaly is harmless and occurs without any clinical manifestations. But in some people, such a pathology contributes to the development of an ascending infection that requires appropriate treatment.

With echography, the kidney pyramids, which are normally hypoechoic (dark gray), become hyperechoic (white) as a result of an increase in the number of reflective media interfaces due to the expansion of the tubules.

With age, secondary calcification of dilated collecting ducts is possible, as well as the formation of cysts in the cortex of the abnormal organ. In this case, the spongy kidney begins to resemble changes in nephrocalcinosis, but without concomitant changes in laboratory tests.

What does cancer look like on an ultrasound machine?

The ultrasound picture of cancer is very diverse. The most common malignant tumor of the kidney is renal cell carcinoma. Tumors of small size are often hypoechoic, large ones are usually hyperechoic or contain areas of mixed echogenicity due to changes occurring in the tumor. Often, kidney cancer is isoechoic, that is, identical in structure to the surrounding tissue and thus very difficult to distinguish from it. Isoechoic cancer less than 1 cm in size is especially difficult to detect with ultrasound. Small tumors usually have a regular round shape, relatively even contours.

kidney cancer

Large cancer is characterized by heterogeneity of the structure with areas of increased echogenicity due to fibrosis and areas of reduced echogenicity. Areas of calcification may be seen. In the foci of cancer decay, cystic cavities are formed containing fluid, blood or jelly-like masses. The areas of decay on echography look like an- or hypo-echogenic cavities of irregular shape.

Sonographic signs of cancer may include the following changes:

• volumetric formations having a different acoustic density than the parenchyma;
• limited protrusions of the organ contour;
• cysts with a very dense or uneven wall, with hemorrhage;
• discontinuity of echo signals from the central echo complex, detection of parenchymal bridges;
• Dopplerography in cancer reveals a staining defect, where the normal architectonics of the renal vessels disappears, the degree of vascularization can be different - from the complete absence of an image of the vessels to high vascularization with multiple amplification of the color signal.

Humpback kidney - what is it?

Sometimes on the surface of the organ, more often the left one, a bulging of its external contour is revealed. In some cases, it is mistaken for a tumor, but upon closer examination, it is established that this is an individual feature of the structure of the organ in the patient and does not pose any danger to the life and normal functioning of the organ. In this case, the doctor puts the phrase “humped kidney” in the description of the ultrasound. It arises either from the pressure of the spleen on the kidney, or as a result of violations in embryonic development.

What does the darkening in the kidney mean?

In relation to instrumental diagnostics, the term "darkening" is used in radiology. In the sonographic description, structures that appear darker than the surrounding tissues are referred to as "hypoechoic" or "reduced echogenicity". Completely black structures are called "anechoic".

Hypoechoic areas can be the following changes:

• abscess;
• tumor;
• hemorrhage;
• in addition, pyramids are normal hypoechoic structures in the parenchyma.

Completely black, "anechoic" may be: cysts and dilated pelvises or calyces as a result of urinary retention.

Further actions, tests, diagnosis after ultrasound of the kidneys

After the ultrasound diagnostics, the doctor gives the patient a protocol of examination or hands it over to the attending physician. The ultrasound conclusion is not a final diagnosis, but only serves as an aid to the doctor in diagnosing the changes taking place in the patient's body. The doctor, on the basis of not only the ultrasound description and conclusion, but also analyzing the complaints, examination of the patient, laboratory tests of the patient, makes the final diagnosis and prescribes the necessary treatment.

If the doctor does not have enough of these data, or during the ultrasound of the kidneys, some obscure abnormalities were found that can occur in various diseases, the attending physician prescribes additional examination methods to the patient. This can be computed tomography, magnetic resonance imaging, excretory urography, radiography, angiography, various laboratory tests of urine and blood, or a control ultrasound over time.

Conclusion

Ultrasound examination in most cases allows the doctor to make an accurate diagnosis and prescribe the necessary treatment for the patient. Due to its wide availability, harmlessness and high information content, this examination method is among the first to be prescribed for suspected almost any diseases of the kidneys and urinary system.

Diagnosis of kidney stones

Diagnosis of kidney stones begins with a consultation with a doctor. The doctor will be interested in questions related to your disease: what symptoms bother you, when they appeared, how severe they are, whether relatives suffer from kidney stones, and much more.

To make the consultation as productive as possible, you can prepare for it. What can you do:

• Write down on a piece of paper all the symptoms that bother you, even those that, in your opinion, are not associated with kidney stones;
• Make a list of all medications you take, including vitamins and dietary supplements;
• Prepare a statement of your diseases, in addition to kidney stones, surgeries, etc. In addition, you can take with you the results of previous examinations;
• Make a list of relatives who also suffer from kidney stones. You can take a family member with you to the consultation, sometimes a loved one can tell you important information that you forgot about;
• Write down on the sheet all the questions you would like to ask the doctor.

Physical examination also plays an important role, it allows the doctor to assess the general condition and exclude the presence of other, non-urological diseases that can mimic the presence of kidney stones.

Already at the consultation, it is possible to make a preliminary diagnosis and even suggest the type of kidney stone!

What tests to take?

The next stage in the diagnosis of a kidney stone is laboratory research, first of all, general urine analysis.

An indirect sign of the presence of a kidney stone may be the detection salt crystals in urine. The type of salt found can provide preliminary information about the chemical composition of the calculus. For example, if the urine contains a lot of oxalates, then there is a high probability that there is a calcium oxalate calculus in the kidney.

In addition, it is also important acidity index, urine pH. A urine pH of 7 is considered neutral, a solution with a pH below 7 is considered acidic, and above 7 is considered alkaline. Patients with urinary stones acid urine is always more acidic, and in people whose stones have formed due to infection, alkaline urine. The acidity of the urine also helps to suggest the type and chemical composition of the stone.

If bacteria are found in the urine, this with a high probability may indicate the presence of a struvite calculus in a person or a concomitant infectious complication of a kidney stone. The appearance of inflammatory cells, leukocytes, in the urine is common with any kidney stone, so the presence of leukocytes in the absence of bacteria in the urine does not always indicate infection.

It is also routinely performed for all patients general and biochemical blood test. This is necessary for the diagnosis of a kidney stone and its complications.

Analysis of daily urine- This is a study of urine collected in 24 hours. Analysis of daily urine is necessary to assess the volume of urine separated per day, the level of acidity, the content of salts and crystals in it. Appointed according to indications.

A kidney stone, as well as renal colic, often have symptoms similar to many other diseases, including non-urological ones. Although the history and physical examination are important in the diagnosis of kidney stones, one of the imaging tests, i. such an examination, which will make it possible to see the stone and determine its size, shape and location. Currently, several types of studies are available for the diagnosis of kidney stones, the advantages and disadvantages of which are outlined in the table.

Methods for diagnosing kidney stone and their effectiveness:

Sensitivity- an indicator reflecting the probability of finding a calculus. Specificity- this, on the contrary, is an opportunity to exclude the presence of a disease, i.e. confirm its absence.

Now let's take a closer look at each method for diagnosing kidney stones separately.

Ultrasound of kidney stones

Ultrasound of kidney stones (ultrasound)- a ubiquitous method for diagnosing various diseases of internal organs, including kidney stones, using ultrasonic waves.

Ultrasound has limitations in the diagnosis of urolithiasis. Ultrasonography is readily available, quickly performed, and highly effective in diagnosing a kidney stone, but it rarely detects a stone in the ureter (sensitivity is 19%). On the other hand, ultrasound can diagnose hydronephrosis, which may be an indirect sign of blockage of the ureter by a stone. Hydronephrosis - expansion of the ureter and pyelocaliceal system of the kidney above the site of blockage.

Ultrasound examination helps the doctor to exclude the presence of other diseases that mimic an attack of renal colic, for example, appendicitis, cholecystitis, torsion of the uterus, etc.

Ultrasound is the method of choice for diagnosing kidney stones in pregnant women.

Kidney stone x-ray

Picture. X-ray shows multiple kidney stones.

Plain x-ray- a method for diagnosing a kidney stone, which allows to identify an X-ray contrast calculus, determine its size and location. X-ray contrast stone- This is a calculus that is clearly visible on an x-ray. Calcium stones are clearly visible on x-rays. Diagnosis of kidney stones from uric acid, cystine or magnesium ammonium phosphate (infectious calculi) using plain radiography is difficult or even impossible, as they are poorly visible in the picture.

Often, even an X-ray contrast stone can not be seen in the picture due to gases accumulating in the intestines, or the imposition of the shadow of the calculus on the shadow of the vertebrae. And such non-urological phenomena as calcification of the lymph nodes in the abdominal cavity, gallstones, etc., can imitate a calculus in the picture.

Thus, it is clear that both the sensitivity and specificity of this method for diagnosing a kidney stone is low.

X-ray with contrast for kidney stones

X-ray of the kidneys with contrast- one of the main methods for diagnosing a kidney stone. X-ray of the kidneys with contrast provides valuable information about the calculus (its size, location and X-ray contrast), the state of the urinary system (structure of the pyelocaliceal system, ureters, etc.) and kidney function. The study is accessible and inexpensive. Unlike a simple x-ray it allows you to distinguish a kidney stone from other X-ray contrast particles (calcifications of the gallbladder, calcification of the lymph node, etc.).

Picture. An x-ray taken ten minutes after the injection of a contrast agent into a vein.

Compared to diagnostic ultrasound and plain radiography, X-ray kidneys with contrast has a higher sensitivity and specificity. During this study, it is necessary injection of a contrast agent into a vein. After some time, when the substance enters the urinary system, a series of x-rays is taken.

The disadvantage of this method of diagnosing a kidney stone is the possibility development of an allergic reaction to the contrast agent. But, if you have ever applied iodine to your skin and there was no allergic reaction, then there is nothing to worry about.

Computed tomography of kidney stones

CT scan is a method widely used throughout the world for the diagnosis of kidney stones. This diagnostic method allows you to quickly identify the calculus any kind, size and location. Computed tomography has high sensitivity and specificity, it allows to exclude the presence of other diseases that mimic a kidney stone or renal colic. In addition, the diagnostic method provides information about the structure of the urinary system, degree of blockage in the ureter calculus. Flaw- inability to evaluate kidney function. Another significant disadvantage is high price diagnostics. For example, in the USA the cost of a CT scan is $600, and an intravenous pyelography is $400. However, the speed and high efficiency of computed tomography makes this method indispensable in the diagnosis of kidney stones. Therefore, computed tomography is gradually becoming the gold standard and the method of choice for diagnosing a calculus in the kidney.

Picture. CT scan. The picture clearly shows a large stone in the right kidney.

Ultrasound of the ureters is a type of informative ultrasound diagnostics, which is used for suspected urolithiasis and other diseases of the urinary system. This is a painless procedure that allows you to make a diagnosis in a short time. How and when is an ultrasound performed for stones in the ureter?

Ureters: functions and features

The meaning and role of the ureters

The ureters are tube-shaped and connect the kidney to the bladder. Their main function is to conduct urine from the renal pelvis to the bladder, preventing it from moving in the opposite direction. The pelvis of the kidney is a connection of small vessels of the kidney, in which urine accumulates.

The ureters are partly made up of muscle tissue, which allows them to contract, keeping urine from the bladder back to the kidneys. As you know, in a healthy person, the right kidney is located slightly lower than the left, respectively, and the right ureter is a couple of centimeters shorter than the left. The normal length of the ureters is 28-34 cm.

The ureter does not have the same diameter along its entire length. It narrows in three places: at the point of exit from the pelvis of the kidney, in the middle and at the point of entry into the bladder. This is normal and is not a pathology. However, it is in the places of narrowing that stones can get stuck, which cause pain, impaired urination. Urine enters the bladder through the ureters not in a continuous stream, but in small portions every 20 seconds.

The contracting sections of the ureters are called cystoids (inflammation of the bladder - cystitis).

To determine their inflammation or pathology is possible only with the help of:

• Urinalysis
• Ultrasound of the ureters
• X-ray

Almost all diseases of the ureters are accompanied by severe pain in the lower abdomen, which is aggravated by urination, but there are few such diseases and they do not occur too often. Pathologies can be congenital, caused by inflammation, trauma, cancer, benign tumors.

Congenital diseases of the ureters begin to develop even in the prenatal period of life.

Under the influence of negative factors, the fetus begins to develop incorrectly. Acquired diseases are usually associated with obstruction of the ureters.

If the patient is admitted to the hospital with complaints and the doctor suspects a pathology of the ureter, the first test will be a urine test for erythrocytes and leukocytes, which will indicate an inflammatory process in the genitourinary system. Then either cystoscopy or ultrasound, CT, X-ray is prescribed to see the cause of the disease. Cystoscopy is a type of endoscopy, only a tube is inserted into the urethra. However, with severe pain or bleeding, this method can be quite painful. Then it is replaced by an ultrasound or x-ray.

Indications for ultrasound of the ureters

Appointment for examination

As mentioned above, a rare disease of the ureters does without severe pain. It is this that is most often an indication for ultrasound of the ureters. However, pain in the lower abdomen can mean anything, so the doctor palpates and collects an anamnesis before ordering an ultrasound.

The ureters are not palpable on examination of the abdomen, but a doctor may suspect a medical condition if the pain increases along the location of the ureters.

Pain can be a signal of urolithiasis.

By themselves, stones in the ureter are only a consequence of a more serious disease, metabolic disorders. The pain is very strong, sharp, in the lumbar region. This pain is called renal colic. The pain may move along with the stone, with brief periods of relief. There may be blood in the urine. If the stone is in the lower part of the ureter, the pain will be in the suprapubic area.

With urolithiasis, ultrasound is indispensable. This is a quick and safe procedure that allows you to see changes in the ureters and determine the number of stones, their size and location. It is very important to see in time a motionless stone that blocks the ureter and does not allow urine to move into the bladder.

More information about ultrasound of the ureters can be found in the video.

If this condition is not treated, the kidney may die. In addition, sharp stones scratch the ureteral mucosa or form a “bedsore”, which, even after the removal of the stone, will interfere with normal urination.

Purpose of ultrasound:

• Indications for ultrasound of the ureters is also frequent urination, blood in the urine.
• When urination can be painful, burning, urine comes out with difficulty and in small portions.
• The doctor may prescribe an ultrasound even if there are no clearly expressed complaints, but urine and blood tests revealed any pathologies.
• Ultrasound is also performed for prevention, when checking the effectiveness of treatment of ureteral diseases, for examination before surgery and kidney transplantation.

Ultrasound helps to identify and observe various congenital and acquired anomalies of the kidneys. Often they are inoperable or do not require surgical intervention, but they need constant monitoring. Anomalies may relate to the number of ureters, their shape, size, position. If the anomaly interferes with normal urination, disrupts the outflow of urine and leads to various complications, the only way to treat is surgery.

Training

Proper preparation for the ultrasound procedure

There are rules for preparing for an ultrasound of the ureters, they depend on the type of procedure, disease, symptoms:

• For the best view, assessment of the size and structure of the bladder and ureters, it is desirable that the bladder is full. Therefore, 2 hours before the ultrasound, the patient is asked to drink about 2 liters of water and not urinate until the procedure. Instead of water, you can drink weak tea, juice or compote. Water should not be carbonated.
• For some procedures, the patient must not urinate for 6 hours before the ultrasound. This can be difficult, especially for people with frequent urges to urinate. If it is hard to hold back, you need to urinate partially, and then again drink a glass or two of liquid. Then by the time of the procedure, the bladder will be filled again.
• If the procedure is scheduled for the morning, you can not follow a special drinking regimen, but simply do not urinate in the morning. If this is too difficult, you can get up at 2 or 3 am on an alarm clock and go to the toilet.
• When examining the ureters of a pregnant woman after the 1st trimester, it is not necessary to fill the bladder.
• For patients with urinary incontinence, fluid is administered through a catheter immediately prior to the procedure.
• In some cases, an ultrasound of the ureters is performed rectally, for example, to look at the prostate at the same time. In this case, it is recommended to completely clean the intestines with an enema.
• A full bladder will make diagnosis easier, but a full bowel will not. It is desirable that it be emptied. In people prone to flatulence, gases accumulate profusely and interfere with a reliable diagnosis. Therefore, 2-3 days before the ultrasound, it is advisable to give up products that increase gas formation, carbonated drinks, and alcohol. If necessary, you can drink drugs that reduce gas formation.
• In addition to the diet associated with flatulence, no special nutritional principles need to be followed. The procedure is carried out regardless of the fullness of the stomach.

Ultrasound of the ureters may be performed along with other procedures. For example, ultrasound of the kidneys and ureters is performed with a kidney biopsy. A biopsy involves taking a small piece of tissue for a more detailed examination. Most often, a biopsy is taken in a closed way through a puncture.

Preparation for ultrasound during biopsy requires a special approach. Most often, you need to pass urine and blood for analysis, with increased pressure, a small course of treatment is carried out to reduce it, a preparatory ultrasound. It is also necessary to minimize the intake of any medications.

Procedure and decryption

Ultrasound of the ureters

An ultrasound of the ureters is usually done in conjunction with an ultrasound of the kidneys. This procedure is performed through the wall of the peritoneum or through the vagina or anus. Most often, it is the external method of research that is used. But if a person is obese or has a complex diagnosis, other methods are used.

The patient lies on his back, a special gel is applied to his stomach and a diagnosis is made. With the transvaginal method, the woman is asked to bend her knees. During transrectal ultrasound, the patient lies on his side and pulls his knees to his stomach. A special sensor is inserted directly into the vagina or anus. To facilitate the procedure, a special nozzle and gel are used.

In some cases, several research methods or all three are recommended at once, for example, if the diagnosis is controversial and more detailed consideration is required. The ultrasound procedure is painless and safe, it takes only 10 minutes. Only a urologist can decipher the result.

During the ultrasound procedure, the specialist assesses the shape and size of the bladder, its contours, the presence of tumors in the ureters and bladder, the presence of stones, blood clots, abnormalities of the ureters, their size and expansion.

With urolithiasis, a specialist will be able to consider the size of the stones, their location, number, shape.

The ureters on ultrasound are not always visualized well, so the doctor may prescribe other methods of examination. For example, the middle part of the ureters is always poorly visible.

There are various signs of pathology of the kidneys and ureters on ultrasound:

1. Education with increased or decreased echogenicity. Such formations look like dark spots. The specialist describes the size and contours of education. It could be a tumor or a cyst.
2. Education, which has both increased and decreased echogenicity. If the formation has a heterogeneous structure, this means that it has fluid inclusions. Usually in this case they speak of a benign or malignant tumor.
3. Irregular edges of the kidney and ureters. This may be the cause of congenital pathology or inflammation.