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case № 0008
Diagnosis:

Vascular abnormalities of the kidneys - a doubling of the renal artery, compression of both ureters. Condition after complications of pregnancy and childbirth. Bilateral ureterohydronephrosis III degree. Bladder - renal pelvis reflux. Extravasal compression of right ureter by  additional inferior right renal artery. Extravasal compression of the left ureter additional inferior left renal artery. Compression of the left ureter by enlarged venous plexus of kidneys gate and varikoovariuum. Strictures of upper part of both ureters. Urethral stricture. Chronic renal failure I degree. Secondary chronic recurrent bacterial cystitis, pyelonephritis. Aorto-mesenteric compression of the left renal vein. Secondary varikoovarium from the left side. The syndrome of pelvic venous plethora. Hypertension (periodically with fluid retention, urine). Splanchnoptosis.Nephroptosis, cystocele. Retroflexio of uterus ( before pregnancy was anteflexio).

Case description:

Date of birth - 21.04.1986

Complaints on pain in the lumbar region on both sides, especially on the left, pain in the ureters (particularly during urination), and not just urinating, forced standing tilted forward, difficulty, faltering, sometimes splashing urine when urinating, forced supine position for filling of the bladder and to reduce pelvic  venous plethora. Condition after complications of pregnancy and childbirth (19.10.2011).

On 32 weeks of pregnancy patient noticed a decrease of diuresis, about 500-700 ml of urine per day, and with the growth of the fetus condition became worse, later developed hydronephrosis and pyelonephritis. On  34 weeks of gestation was hospitalized to hospital with a diagnosis pregestosis (slightly delayed liquid and visible swelling was not yet). The patient was conducted to intensive resuscitation unit and to her was provided intensive  infusion therapy. Weight before the intensive care unit was 61 kg, and after 3 days became 69 kg. Urine was almost red,  in the urine was high protein, red blood cells, white blood cells. Delivery was  stimulated at 37 weeks of gestation, during  childbirth began moderate  preeclampsy. There was also the trauma of the urethra, bladder when the catheter of Foley  was wrong  removed after delivery  about a week was bleeding from the urethra. The urine in the bladder is not fixed as it used to prior to pregnancy, there is a bilateral reflux. After delivery, began to disappear all the liquid, resulting in fallen of organs : two kidneys, bladder, and other organs. The uterus changed position from anteflexio to retroflexio.

After delivery, when the patient is in standing position, the urine moves in small portions with the strong arching of back pain, feeling of heaviness in the pelvis. Before pregnancy these complains were absent. And when patient is in horizontal position, the urine sample is much more in volume and for urine it's easier to reach the bladder, passes a feeling of heaviness in the pelvis. 2-3 hours of  lying may deviate from 500 -850 ml of urine and urine sample is larger, compared to being in an upright position. Now often develop permanent chronic cystitis and pyelonephritis from January 2015, as soon as the urine is delayed, because of what is patient often takes antibiotics, and there is resistance to the drugs. Before pregnancy concerning  urology and nephrology were no complaints.

During the cystoscopy was found deformation of the bladder; difficulty urinating, intermittent (reflux is present), cystocele. Before pregnancy blood pressure was 120/80 mm Hg, and after is 90/60 mmHg. Periodically, there are rises in blood pressure on the background of fluid retention, and violations of the outflow of urine output.

31.08. 2014 was performed surgery to stenting of the left renal vein. But retrograde flow on the left ovarian vein is still preserved and compressed the left ureter.

Concomitant diseases - Chronic duodenitis. Respiratory Syndrome (a cardiac etiology). Echocardioscopy from 04.12.2015: Minimum PMK with regurgitation at the level of the valves. Partly tricuspid insufficiency. Blood flow in the abdominal aorta is pulsating. Myopia -3,5-4 diopters.

 

 

Matvienkova Ekaterina

 

The wishes of the patient -  consultation of the urologist, vascular surgeon + the operation to save renal function.