What is bladder exstrophy in children, why does it appear, how to prevent development? Examination of the fetus - ultrasound Full urinary in the fetus on ultrasound.

It is difficult to remain indifferent at the sight of such a severe anomaly in the development of the genitourinary system as exstrophy of the bladder, detected in newborns. With this malformation, the bladder loses its spherical shape, it seems to be turned outward.

Translated from the Greek "ekstrophe" is "eversion". Since the abdominal wall is partially absent in this defect, it is replaced by the mucous membrane of the bladder of a bright red color, which, when touched, begins to bleed.

Classification of types of exstrophy

This malformation of the genitourinary system is laid as early as 4-6 weeks of intrauterine development of the child, when the formation of the main human life support systems takes place. In this case, the bones of the pubic articulation do not form a lock, and the bladder remains open to the outside, not located in the abdominal cavity.

Since only the back wall remains of the bladder, the ureters do not pour urine into the bladder, but outward - onto the skin of the abdomen and perineum. Their openings are clearly visible in the lower third of the organ turned inside out.

This most complex defect belongs to the exstrophy-epispadias complex, which includes:

• Epispadias (splitting of the urethra) of varying severity;
• The classic form of exstrophy;
• Cloacal exstrophy of the bladder, combined with severe lesions of the bone, digestive, nervous and urinary systems.

There are no two identical cases of exstrophy, its severity is assessed by the size of the defect, the preservation of the normal morphology of the mucosal tissues. Pathology can be combined with epispadias, as well as with a doubling of the vagina, the absence of one kidney, cases are described when the child had 2 bubbles, one of which was normally functioning.

Clinical picture of the disease

Changes in the anatomy of the bladder in newborns suffering from a birth defect:

First.

The urethra in boys is shorter than the usual length, it is split along the entire anterior wall, or partially. The clitoris in girls is also split, and the unformed urethra comes out between them with the labia.

Second.

The penis in boys is pulled up to the stomach due to a shortened tendon.

Third.

The sphincter of the bladder is open due to splitting, its neck, which restrains spontaneous urination, is absent.

Fourth.

The area of ​​the bladder mucosa is so small that even with a successful plastic surgery, the organ cannot hold the usual volume of urine, although it has the opportunity to grow and increase its volume in the future.

Fifth.

The ureters are in an unfamiliar location, which increases the risk of backflow of urine into the kidneys.

Sixth.

The pubic bones do not form an articulation that protects the genitourinary system from accidental damage - diastasis of the bones of the womb of various sizes is diagnosed. The divergence of the pubic bones can lead to stretching of the anal sphincter by the anorectal muscles, which subsequently leads to fecal incontinence.

Seventh.

Both the urethra in children of both sexes, and the vagina in girls, and the penis in boys have sizes that differ from the norm, they are smaller in size.

Eighth.

The distance between the anus and the navel is shorter than usual, the anus is higher, and the navel, on the contrary, is lower than usual. If the digestive system has no defects, then this location of the anus does not affect the functioning of the gastrointestinal tract. The navel is further formed in a new place for aesthetic reasons.

If a child is diagnosed with bladder exstrophy, 80% of boys and 10% of girls will develop an inguinal hernia.

Due to the fact that urine is continuously excreted from the ureters, the surrounding tissues are irritated by urinary salts. The skin of the thighs and the skin around the open area is constantly macerated, the epidermis swells and loosens. The infection on the open mucosa causes infection of the ureters and kidneys.

Reasons for the development of a defect

The pathogenetic cause of the appearance of pathology is the incomplete formation of the walls of the bladder during embryonic development. The reason for this was the delay in the reverse development of the cloacal septum due to the influence of many teratogenic factors.

These factors have not yet been identified with 100% accuracy. It is believed that the prerequisites for the appearance of such a pathology as exstrophy of the bladder may be:

• Intrauterine infections;
• smoking during pregnancy;
• Side effects of medications;
• Embryo injury;
• Exposure to radiation.

There is an assumption that a large proportion of cases of the appearance of a defect are associated with hormone-dependent pathologies: diabetes mellitus, hyperthyroidism, pituitary tumor, hyperplasia of the adrenal glands of a pregnant woman.

Diagnostics

Visual diagnosis of pathology occurs immediately after childbirth, since such changes in the anatomy of the newborn cannot be overlooked. A newborn with such a defect is sent as soon as possible to a specialized urological clinic specializing in operations of this kind.

To identify combined defects, the following studies are carried out:

• X-ray of the abdominal cavity;
• Ultrasound of the genitourinary system, intestines, spinal cord;
• Excretory urography for diagnosing the rate of development of the kidneys and ureters.

When performing an ultrasound as part of screening for the second trimester of pregnancy, the doctor may suspect that the fetus has bladder exstrophy, for a number of signs:

• There is a bulge on the anterior wall of the fetal peritoneum;
• The shadow from the bladder is not visible, it is not possible to fix its filling and emptying;
• The umbilical cord is located lower than usual;
• The anus is located higher than usual;
• The shape of the genitals is changed.

Divergence of the pubic symphysis (diastasis) during ultrasound screening is extremely rare.

Treatment

The only method of treating exstrophy is surgical plastic surgery of the organ, its closure. At the beginning of the last century, this pathology was considered a defect incompatible with life. And today, unoperated children rarely live beyond the age of 10.

Tasks solved by surgical intervention:

• Restoration of the anterior peritoneum and bladder;
• Creation of a normally functioning penis, acceptable aesthetically;
• Preservation of the functions of the urinary system, ensuring the retention of urine.

A patient suffering from exstrophy needs a series of surgeries. They are carried out, starting from birth, in a certain sequence:

Step one.

Closure of the bladder and the anterior wall of the peritoneum using own tissues, determining the frequency of urinary incontinence. If there is a shortage of tissue, the defect is closed with a temporary synthetic implant.

Step two.

Surgical correction of the organ, removal of the implant, in combination with the use of antibiotics to prevent secondary infection.

Step three.

Bladder neck plastic.

Solving other problems at the same time- excision of an inguinal hernia, lengthening and straightening of the penis in boys, osteotomy in case of pubic bones divergence, cosmetic plastic surgery of the navel and genitals. It is desirable to regain control over urination as early as possible, so operations are carried out immediately after birth.

When splitting the ureters, they are removed into the sigmoid colon. If it is impossible to create an organ from one's own tissues, an artificial bladder is formed, which is emptied at the request of the patient.

Complications

If the operation is delayed, the newborn is threatened with heat loss due to a defect in the peritoneum. For this, the child is placed in a special incubator that helps maintain body temperature.

Infection of the defect with pathogenic microbes can cause the development of peritonitis and sepsis. Therefore, to prevent such a complication, children with such a defect are given a course of antibiotic therapy immediately after birth.

After repeated surgery, adhesions may appear due to the loss of fibrin into the abdominal cavity. In the future, adhesive cords cause severe pain and intestinal obstruction.

Forecast

With correct treatment, 20-80% of children recover the function of the bladder, they can lead a normal life, continue to retain their reproductive functions, and can live a normal sexual life.

In the remaining patients, urinary incontinence persists, and there remains a high risk of infection of the kidneys and ureters. In most cases, complications persist in patients with pubic symphysis divergence and concomitant malformations.

Prevention

Although the appearance of exstrophy is diagnosed in one of tens of thousands of cases of childbirth, the prevention of pathology should be carried out even at the stage of pregnancy planning. It is very important to exclude the multifactorial effect of teratogenic causes at the stage of formation of the main organs - during the first or second month of pregnancy.

During pregnancy, the antenatal clinic should be tested for such embryotoxic infections as cytomegalovirus, rubella, toxoplasmosis, herpes, as well as for the presence of chromosomal pathologies.

Yesterday I had a similar situation, but we were told that the stomach is small. and today on the second ultrasound they said that everything is within the normal range. so don't worry, everything should be fine! and about the fact that he sits on the priest for up to 36 weeks, you need to do gymnastics like this I found on the Internet: The basic principle of exercise therapy is a set of exercises for the oblique muscles of the abdomen, combining them with breathing, exercises for stretching the spine,
improvement of the general tone of the cardiovascular system, exercises for the pelvic floor, exercises for the chest.
1. The method of I.F. Dikan is used with a high tone of the uterus and a gestational age of 29-37 weeks.
The pregnant woman, lying on the bed, turns 3-4 times alternately on the left or right side and lies on each of them for 10 minutes. Such classes are carried out 3-4 times a day for 7-10 days.
2. Methodology V.V. Fomicheva:
Introductory part: normal walking, on toes, on heels, walking forward and backward with the rotation of the arms bent at the joints, walking with high knees to the side of the abdomen.
Main part:
o Starting position - standing, feet shoulder-width apart, arms lowered. Tilt to the side - exhale, Starting position - inhale. Repeat 5-6 times on each side.
o Starting position - standing, hands on the belt. Tilt back - inhale, slowly lean forward, bending in the lumbar region - exhale.
o Starting position - standing, feet shoulder width apart, hands on the belt. Spread your arms to the sides - inhale, with the turn of the torso to the side bring the legs together - exhale. (3-4 times).
o Starting position - standing facing the gymnastic wall, holding outstretched hands on the rail at waist level. Raise the leg bent at the knee and hip joint on the side of the abdomen with the knee reaching the hand lying on the rail - inhale; lowering the leg, bend in the lumbar spine - exhale. Repeat 4-5 times with each leg.
o Starting position - standing sideways to the anthem. Wall, leg on the 2nd crossbar from below, hands on the belt. Spread your arms to the sides - inhale, turn the torso and pelvis outward, slowly tilt the torso with lowering the arm down in front of you - exhale. Repeat 2-3 times on each side.
o Starting position - kneeling, leaning on your elbows. Alternately raising the straight leg up. 5-6 times with each leg.
o Starting position - lying on the right side. Flexion of the left leg in the knee and hip joints - inhale. Starting position - exhale. 4-5 times.
o Starting position is the same. Circular movements of the left leg 4 times in each direction.
o Starting position on all fours. "angry cat" 10 times
o On the left side ex. 6, 7.
o Starting position - on all fours, legs resting on the front of the foot. Straighten your legs 4-5 times in the knee joints, lifting the pelvis up.
o Starting position - lying on your back, resting on your heels and back of your head. Raise the pelvis up - inhale, Starting position - exhale. 3-4 times. The final part is 3-5 slow exercises sitting and lying down.
3. The technique of Bryukhina, I.I. Grishchenko and A.E. Shuleshova:
Exercises are performed before meals 4-5 times a day.
o Lie on the side opposite the fetal position. The legs are bent at the hip and knee joints. Lie down 5 min. Straighten the upper leg, then press it to the stomach with an inhalation and straighten it with an exhalation, bending slightly forward and giving a slight push towards the back of the child. Repeat this movement slowly for 10 minutes.
o Lie down for 10 minutes without moving.
o Take the knee-elbow position and stay in it for 5-10 minutes.
4. Additional exercises to the Fomicheva complex:
o Starting position - kneeling, leaning on your elbows. Spread your knees wider to the sides. Touch the chin of the hands - exhale, starting position - inhale. 5-6 times
o Starting position - the same. Raise the right leg up, take it to the side, touch the floor, return to the starting position 3-4 times in both directions.
o Exercises for the muscles of the perineum.
o Starting position - lying on your back. Legs shoulder width apart bent at the knees. We lower the knee of one leg to the heel of the other. We do not tear off the buttocks.
o Starting position - lying on your back, legs straight, shoulder width apart. We bring straight feet inward, outward, trying to put them on the floor. 10 times
o Starting position - on all fours. We walk with our palms on the carpet to the left, to the right. 6 times.
o Starting position - sitting on the floor, hands in support behind. Walk 3 steps back with your palms, raise your pelvis, lower it and go forward with your palms until your stomach gets in the way.
o Diaphragmatic breathing, lying on the stomach.
o Exercises for the chest and shoulder girdle.
Special exercises

Using Gravity

The intended effect of these exercises is that gravity pushes and rotates the fetal head against the fundus of the uterus, and the baby itself turns into a cephalic presentation.

Tilt of the pelvis. Performed on an empty stomach. You need to lie on your back on an inclined surface, raising your pelvis 20-30 cm above your head. In the absence of a special simulator, you can use pillows folded on the floor in front of a low sofa.

Stay in this position for at least 5 minutes, but no more than 15 minutes. Perform this exercise 2 times a day for 10 minutes for 2-3 weeks, starting at 32 weeks. Studies show that this method is effective in 88-96% of cases.

Knee-elbow position. An alternative to the previous exercise. Get on your knees and elbows, at this time the pelvis is located above the head. Stay in this position for 15-20 minutes several times a day. Yoga. The classic shoulder stand position is used.

Swimming pool. Diving with handstands has been reported to be effective. The last two sets look quite exotic and require almost professional training.
While there is no scientific evidence to support these techniques, their use does not cause harm and even allows you to devote more time to your unborn child.

Suggestion. Use the power of suggestion, tell the child to turn around. You can ask your partner to talk to your child. Visualization. During deep relaxation, visualize the child turning. Try to imagine not the process of turning, but the child who has already turned.

Light. The location of a source of light or music directly above the womb causes the fetus to turn towards the light or sound. Place a flashlight near the perineum so that the child can turn towards the light.

Music. Place the player's headphones with pleasant music under the clothes in the lower abdomen, this will encourage the child to move towards the music. This technique can be quite effective.

Water. There is evidence that when swimming or just being in the pool, the fetus turns. With care, visiting the pool is not associated with any special problems.

How to keep the baby in cephalic presentation after a successful turn?

Tailor's pose. It helps to move the head deeper into the pelvic cavity. Sit on the floor, put the soles of your feet together. Press your knees as close to the floor as possible, and pull your feet towards you. Apply this pose for 10-20 minutes 2 times a day until the onset of labor.

- functional disorders of filling and emptying the bladder associated with a violation of the mechanisms of nervous regulation. Neurogenic bladder in children may present with uncontrolled, frequent or infrequent urination, urinary urgency, urinary incontinence or retention, and urinary tract infections. Diagnosis of neurogenic bladder in children is based on laboratory, ultrasound, X-ray, endoscopic, radioisotope and urodynamic studies. Neurogenic bladder in children requires complex treatment, including drug therapy, physiotherapy, exercise therapy, and surgical correction.

General information

Neurogenic bladder in children is a reservoir and evacuation dysfunction of the bladder, caused by a violation of the nervous regulation of urination at the central or peripheral level. The relevance of the problem of neurogenic bladder in pediatrics and pediatric urology is due to the high prevalence of the disease in childhood (about 10%) and the risk of developing secondary changes in the urinary organs.

A mature, fully controlled day and night, urination regimen is formed in a child by the age of 3-4, progressing from an unconditioned spinal reflex to a complex voluntary reflex act. Its regulation involves cortical and subcortical centers of the brain, centers of spinal innervation of the lumbosacral spinal cord, and peripheral nerve plexuses. Violation of innervation in neurogenic bladder in children is accompanied by disorders of its reservoir-evacuation function and can cause the development of vesicoureteral reflux, megaureter, hydronephrosis, cystitis, pyelonephritis, chronic renal failure. Neurogenic bladder significantly reduces the quality of life, creates physical and psychological discomfort and social disadaptation of the child.

Causes of neurogenic bladder in children

The neurogenic bladder in children is based on neurological disorders of various levels, leading to insufficient coordination of the activity of the detrusor and / or the external sphincter of the bladder during the accumulation and excretion of urine.

Neurogenic bladder in children can develop with organic damage to the central nervous system due to congenital malformations (myelodysplasia), trauma, tumor and inflammatory and degenerative diseases of the spine, brain and spinal cord (birth trauma, cerebral palsy, spinal hernia, agenesis and dysgenesis of the sacrum and coccyx, etc. ), leading to partial or complete dissociation of the supraspinal and spinal nerve centers with the bladder.

Neurogenic bladder in children may be due to instability and functional weakness of the formed controlled urination reflex, as well as a violation of its neurohumoral regulation associated with hypothalamic-pituitary insufficiency, delayed maturation of the voiding centers, dysfunction of the autonomic nervous system, changes in the sensitivity of receptors and extensibility of the muscle wall of the bladder . Of primary importance is the nature, level and degree of damage to the nervous system.

Neurogenic bladder is more common in girls, which is associated with higher estrogen saturation, which increases the sensitivity of detrusor receptors.

Classification of neurogenic bladder in children

According to the change in the cystic reflex, hyperreflex bladder (spastic state of the detrusor in the accumulation phase), normoreflex and hyporeflex (detrusor hypotension in the excretion phase) are distinguished. In the case of detrusor hyporeflexia, the urination reflex occurs when the functional volume of the bladder is significantly higher than the age norm, in the case of hyperreflexia, long before the accumulation of normal age-related urine volume. The most severe is the areflex form of the neurogenic bladder in children with the impossibility of independent contraction of a full and overcrowded bladder and involuntary urination.

According to the adaptability of the detrusor to the increasing volume of urine, the neurogenic bladder in children can be adapted and non-adapted (non-inhibited).

Neurogenic bladder dysfunction in children can occur in mild forms (daytime frequent urination syndrome, enuresis, stress urinary incontinence); moderate (lazy bladder syndrome and unstable bladder); severe (Hinman syndrome - detrusor-sphincter dyssenergia, Ochoa syndrome - urofacial syndrome).

Symptoms of neurogenic bladder in children

Neurogenic bladder in children is characterized by various disorders of the act of urination, the severity and frequency of manifestations of which is determined by the level of damage to the nervous system.

With neurogenic overactivity of the bladder, which is predominant in young children, there are frequent (> 8 times / day) urination in small portions, urgent (imperative) urges, urinary incontinence, enuresis.

Postural neurogenic bladder in children manifests itself only when the body moves from a horizontal to a vertical position and is characterized by daytime pollakiuria, undisturbed nocturnal accumulation of urine with a normal volume of its morning portion.

Stress urinary incontinence in puberty girls can occur during exercise in the form of missing small portions of urine. Detrusor-sphincter dyssynergia is characterized by complete urinary retention, micturition during straining, and incomplete emptying of the bladder.

Neurogenic hypotension of the bladder in children is manifested by absent or rare (up to 3 times) urination with a full and overfilled (up to 1500 ml) bladder, sluggish urination with tension in the abdominal wall, a feeling of incomplete emptying due to a large volume (up to 400 ml) residual urine. Possible paradoxical ischuria with uncontrolled release of urine due to the gaping of the external sphincter, stretched under the pressure of an overflowing bladder. With a lazy bladder, infrequent urination is combined with urinary incontinence, constipation, urinary tract infections (UTIs).

Neurogenic hypotension of the bladder in children predisposes to the development of chronic inflammation of the urinary tract, impaired renal blood flow, scarring of the renal parenchyma and the formation of secondary kidney shrinkage, nephrosclerosis and chronic renal failure.

Diagnosis of neurogenic bladder in children

In the presence of urinary disorders in a child, it is necessary to conduct a comprehensive examination with the participation of a pediatrician, a pediatric urologist, a pediatric nephrologist, a pediatric neurologist and a child psychologist.

Diagnosis of neurogenic bladder in children includes taking an anamnesis (family burden, trauma, pathology of the nervous system, etc.), evaluation of the results of laboratory and instrumental methods for examining the urinary and nervous system.

To detect UTIs and functional disorders of the kidneys in neurogenic bladder in children, a general and biochemical analysis of urine and blood, a Zimnitsky, Nechiporenko test, and a bacteriological examination of urine are performed.

Urological examination for neurogenic bladder include ultrasound of the kidneys and bladder of the child (with the determination of residual urine); x-ray examination (micting cystography, survey and excretory urography); CT and MRI of the kidneys; endoscopy (ureteroscopy, cystoscopy), radioisotope scanning of the kidneys (scintigraphy).

To assess the state of the bladder in a child, the daily rhythm (number, time) and the volume of spontaneous urination are monitored under normal drinking and temperature conditions. A urodynamic study of the functional state of the lower urinary tract has a high diagnostic significance in neurogenic bladder in children: uroflowmetry, measurement of intravesical pressure during natural filling of the bladder, retrograde cystometry, profilometry of the urethra and electromyography.

If a pathology of the central nervous system is suspected, an EEG and) and psychotherapy are indicated.

With detrusor hypertonicity, M-cholinergic blockers are prescribed (atropine, children over 5 years old - oxybutynin), tricyclic antidepressants (imipramine), Ca + antagonists (terodilin, nifedipine), phytopreparations (valerian, motherwort), nootropics (hopantenic acid, picamilon). For the treatment of neurogenic bladder with nocturnal enuresis in children older than 5 years, an analogue of the antidiuretic hormone of the neurohypophysis, desmopressin, is used.

In case of hypotension of the bladder, forced urination according to a schedule (every 2-3 hours), periodic catheterizations, taking cholinomimetics (aceclidine), anticholinesterase agents (distigmine), adaptogens (eleutherococcus, magnolia vine), glycine, therapeutic baths with sea salt are recommended.

In order to prevent UTIs in children with neurogenic hypotension of the bladder, uroseptics are prescribed in small doses: nitrofurans (furazidin), oxyquinolones (nitroxoline), fluoroquinolones (nalidixic acid), immunocorrective therapy (levamisole), herbal teas.

In case of neurogenic bladder in children, intradetrusor and intraurethral injections of botulinum toxin are performed, endoscopic surgical interventions (transurethral resection of the bladder neck, collagen implantation at the mouth of the ureter, operations on the nerve ganglia responsible for urination), an increase in bladder volume using intestinal cystoplasty.

Forecast and prevention of neurogenic bladder in children

With the right therapeutic and behavioral tactics, the prognosis of neurogenic bladder in children is most favorable in case of detrusor overactivity. The presence of residual urine in neurogenic bladder in children increases the risk of developing UTIs and functional disorders of the kidneys, up to CRF.

For the prevention of complications, early detection and timely treatment of neurogenic bladder dysfunction in children is important. Children with neurogenic bladder need dispensary observation and periodic examination of urodynamics.

When the fetus grows inside the female body and has already practically grown, a new portion of discomfort associated with a certain gestational age is added to the life of the expectant mother.

Frequent urges "for a little" begin to disturb the woman even in the early stages. Then everything, it seems, normalizes, and by the time the fetus has grown enough to put pressure on my mother's bladder, the urges resume.

But during pregnancy, frequent urges, frequent trips to the toilet and frequent urination are considered the norm. A little annoying, a little unpleasant, but the norm, which you just need to endure.

Natural container for collecting liquid

If you delve into the anatomical subtleties of the structure of the bladder, then its muscles are very elastic and smooth. They can stretch and contract as much as your body requires. Doctors often compare the bladder to a strong plastic bag or reservoir for the accumulation and removal of fluid.

That is, if you stick to this comparison (a bag), then by analogy you can easily trace the properties of the bladder: try to draw water into a regular plastic bag and press down a little. What will happen? It will start flowing! Everything is so simple: in nature and during a simple experiment.

This is what happens during pregnancy...

During pregnancy, not only the mode of functioning of the bladder changes, the structure of the organs itself changes somewhat: they move from their "familiar" places. On the fetus, thanks to its impressive size for the mother's belly, it can already adjust the location of the bladder and put pressure on it so much that the mother constantly feels the urge and visits the toilet more often.

Yes, and the kidneys during pregnancy work in an enhanced mode: they now need to process and remove metabolic products from two organisms at once. While the child's kidneys are not yet developed and cannot function independently, the mother's body serves the physiological needs of the child.

There is no danger that a pregnant woman runs to the toilet too often “for a little one”. “Unauthorized” urination (incontinence, that is) that occurs when coughing or laughing is also not dangerous: the bladder, pressed down by the baby and the uterus, is simply not able to reliably hold the liquid. In principle, there is nothing to worry about, and this phenomenon is temporary. However, to avoid embarrassment, during this period - 24-26 weeks - and then use pads.

For a correct diagnosis, prescribing drug therapy and simply assessing the condition of the bladder, a urologist needs data from an ultrasound examination of the patient. But for the patient himself, the examination is no less important, because the bladder with normal echogenicity can also have hidden problems. In addition, only ultrasound of the bladder allows you to identify and eliminate pathologies in time, which cannot be detected without the help of ultrasound.

As part of the interpretation of the results of ultrasound diagnostics, several parameters that affect the diagnosis are of particular importance. Consider their normal and pathological characteristics.

Video 1. Bladder on ultrasound is normal.

The form

The shape of the urea is significantly influenced by the level of its filling, as well as the condition of the adjacent organs. Transverse images show us a rounded shape, and longitudinal images show an oval-shaped organ. The boundaries of a healthy bladder are visually defined as even and clear..

Features of the organ in women

In the fairer sex, the shape of the urea depends on whether the woman is pregnant at the time of the examination.

The bladder of a woman differs from that of a man in a shorter but wider shape, which must be taken into account by the diagnostician when deciphering the study data.

Structure

The normal structure of the bladder is echo-negative (anechoic) character, but with age, echogenicity increases. This is due to chronic inflammation, which leaves its mark on the state of the organ in elderly patients.

Volume

On average, the capacity of the urea in women is 100-200 ml less than in men, and ranges from 250 to 550 ml, (while the volume of the male bladder is 350-750 ml). In addition, the walls of the organ are able to stretch, therefore, in tall and large men, the volume of the bladder can reach 1 liter. (when filled).

Reference! The average urination rate is 50 ml/h.

Children's bladder has its own characteristics: its volume increases as the child grows. Age norms of bladder volume in healthy children:

• infants (up to 1 year old) - 35-50 ml;
• from 1 to 3 years - 50-70 ml;
• from 3 to 5 years - 70-90 ml;
• from 5 to 8 years - 100-150 ml;
• from 9 to 10 years - 200-270 ml;
• from 11 to 13 years - 300-350 ml.

If an increase or decrease in an organ is detected during ultrasound diagnostics, then a more detailed examination of a small patient is necessary to determine the causes of this phenomenon.

Bubble walls

Over the entire surface of the organ, its walls should be uniform, with a thickness of 2 to 4 mm (thickness is directly dependent on the degree of filling of the organ). If the doctor noticed on ultrasound a local thinning of the wall or its compaction, then this may be evidence of the onset of the pathology.

Residual urine

An important factor that must be studied during ultrasound is the amount of urine remaining in the bladder cavity after going to the toilet.

Normally, the residual urine should not exceed 10% of the total volume of the organ: on average, up to 50 ml.

How to calculate volume?

Usually, the measurement of bladder volume occurs during an ultrasound examination using a mobile ultrasound machine. The capacity of the organ can be calculated automatically: for this, the doctor needs to find out such parameters as the volume (V), width (B), length (L) and height (H) of the bladder.

For calculation is used formula V=0.75хВхLхН

What are they watching?

During an ultrasound examination of the bladder, among other things, pay attention to:

• hematuria (the presence of blood particles in the urine, especially in children);
• sperm in the urine of male patients (this may mean the contents of the gonads are thrown into the urea).

Pathologies

When deciphering the ultrasound data, serious deviations can be detected, which must be immediately treated to avoid complications.

Sediment in the urine (flakes and suspension)

In the analysis of urine or during ultrasound of the bladder, the patient may find flakes and suspensions, which are a mixture of different cells (erythrocytes, leukocytes or epithelial cells). Cells from the walls of the urethra can enter the urea, and this does not indicate pathology. However, sediment in the urine may also indicate the development of certain diseases, such as:

• pyelonephritis (inflammation, often of a bacterial nature);
• nephrosis (a whole group of kidney diseases);
• cystitis (inflammatory disease of the bladder);
• glomerulonephritis (damage to the renal glomeruli);
• tuberculosis (the cause of this serious infectious disease is Koch's wand);
• urethritis (inflammatory process in the urethra);
• renal dystrophy (pathology with the formation of fat inside the kidney structures);
• urolithiasis (in the urinary system, the formation of sand and stones, i.e. stones);
• diabetes mellitus - characterized by a lack of insulin and affects many body systems, including the urinary tract.

The inflammatory process in the bladder is called "cystitis".

Important! The acute form of the disease is characterized by a sharp deterioration in the quality of life: the patient experiences frequent urge to urinate, which becomes painful, and relief comes only for a very short time.

In the chronic form of the disease, ultrasound makes it possible to see a thickening of the walls of the bladder, as well as a sediment at the bottom of the organ. In details .

Cancer

Can cancer be seen on ultrasound? If the attending physician suspects the development of an oncological process, he will recommend undergoing a transabdominal ultrasound examination, as the most comfortable and meaningful. It is it that will make it possible not only to determine the presence of a tumor, but also to assess the degree of its spread, as well as the size and structural features.

Ultrasound allows you to evaluate:

• bladder capacity;
• the clarity of its contours;
• wall infiltration;
• the exit of the neoplasm outside the organ;
• type of growth and form of the tumor;
• regional metastasis;
• status of nearby lymph nodes.

Enlarged lymph nodes do not always mean their metastasis- it can be the result of a variety of processes: from a banal scratch to inflammation in adjacent areas.

On ultrasound, you can see and assess the condition of the upper urinary tract, clarifying the presence of dilation of the ureter and kidneys. The fact is that the cavitary system of the ureter and kidneys can expand due to oncological lesions of the mouth of the ureter, or damage to the urinary tract. However, the main indicator here will be the determination of the stage of the disease., and the listed features will be determined a second time.

Reference! With a tumor size of more than 5 mm, the ultrasound diagnostic method is highly accurate. However, with very small tumor sizes or a flat form of formation, there is a possibility of false negative results.

If doubts remain after the study, it is better to supplement the diagnosis with intracavitary ultrasound techniques (for example, transvaginal or transrectal).

Polyp

The term “polyp” in medicine refers to a benign formation that protrudes into the cavity of an organ. It can be located both on a wide base and on a small and thin leg.

If the polyp is located in the cavity of the bladder, then it is important to evaluate its shape, size and exact location.

neurogenic dysfunction

With neurogenic disorders of the bladder, the doctor will not see any specific picture on the screen of the ultrasound machine. The changes will be similar to the signs observed with infravesical obstruction, that is, it will be found:

• change in the shape of the organ, its asymmetry;
• trabecularity and wall thickening;
• diverticula;
• stones and sediment in the urinary tract.

A sac-like protrusion in the wall of the bladder is medically known as a "diverticulum" (see image on the right).

It communicates with the main cavity with the help of a neck - a special channel.

With this pathology, echographic scanning of the organ is mandatory.

It will help to assess the location, size and shape of the diverticulum, the length of its neck and relation to adjacent tissues and organs.

If a diverticulum is identified, urodynamic studies (cystometry or uroflowmetry) are required to assess bladder outlet obstruction.

blood clots

Sonographically, blood clots can be defined as irregularly shaped masses with increased echogenicity. Rarely have a round or semicircular shape. They are also characterized by heterogeneous echogenicity and jagged edges, may have hypoechoic inclusions, shaped like foci or layered stripes (this is caused by the layering of the clot).

Only in the presence of a persistent sediment formed from blood particles and epithelium can a relative echogenic homogeneity of the clot be observed.

Important! If the patient during the examination changes the position of the body, and the formation in the bladder moves with him, then this indicates the presence of a clot. But if the clot remains near the wall of the organ, then it is very difficult to differentiate it from the tumor.

Stones in the cavity

Stones (the second name for stones) in the bladder are no different from similar formations in the kidneys or gallbladder. All of them are high-density structures that do not conduct echo beams. That is why they are visualized on the device screen as white formations with dark paths of acoustic shadow behind.

A distinctive feature of the stones is mobility. Unlike tumors, they are not attached to the walls of the organ, so they easily change their position when the patient moves. This sign is the basis for reliable separation of the stone from the tumor during the diagnosis.(the latter will not change its position, as it is fixed in the tissue of the organ).

What else can be seen?

Ultrasound examination of the bladder can detect the following phenomena.