Malformations of the bladder. Megacystis in the fetus - what is it, the causes of the development of pathology The bladder is not visualized in the fetus

Today I will tell you about one malformation that can manifest itself, which means that it can be suspected already at the screening of the 1st trimester.

Prune Belly- a syndrome that includes a number of developmental anomalies, among which there are three main ones:

1. weakness, underdevelopment of the anterior abdominal wall
2. bilateral cryptorchidism
3. urinary tract anomalies

In search of information about this syndrome, I did not come across any variations of translations and pronunciations! And in the Italian manner of Prune Belly, and with the French accent of Prune Belly, giving me the impression that this is the name and surname of a certain scientist. As well as the "cut belly" syndrome and the "plum belly" syndrome, s-m Frölich and s-m Obrinsky.
Prune is an English word that translates as plum, although in this context another meaning was meant - prunes, due to the characteristic wrinkled appearance of the anterior abdominal wall, belly translates as belly.


In Russian-language literature, the term "prune belly" is not used, so in the future I will use its English version, I think it will be more correct.
This type of abdominal wall defect was first described by Frölich in 1839, and the term Prune Belly was proposed by Osler in 1901.

Although it is the characteristic appearance of the baby's tummy that is the hallmark of this anomaly, by which the newborn is usually diagnosed, the underlying genitourinary tract anomalies are the most important determinant of overall survival. There is a wide range of severity of manifestations within the syndrome. Some children with severe respiratory and renal disorders die in the neonatal period, while in others the changes are moderate and can be corrected. Severe renal dysplasia, oligohydramnios and, as a result, lung hypoplasia in 20% of cases leads to antenatal death of the fetus and in 30% to progressive renal failure in the first two years of a child's life. Prune Belly-associated genitourinary tract anomalies include

• hydronephrosis
• tortuous dilated ureters
• varying degrees of kidney dysplasia
• enlarged bladder

In addition, other systems may be involved: cardiovascular, musculoskeletal, respiratory, gastrointestinal tract.

It occurs in 95% of cases in boys, but similar changes, including the absence of the muscles of the anterior abdominal wall in combination with anomalies of the genitourinary system, are also described in girls.

As an illustration, I offer a story that I found in the public domain on one of the forums:

"Girls, who are interested, I had such a child with Prune Belli syndrome. I’ll start my story with the fact that neither I nor my husband are sick with anything, the pregnancy was going well, I didn’t sniff the paint, I don’t drink, I don’t smoke, the reason for this situation has not been found, either here or in America. Yes, of course, we were upset by this situation, and if I had been informed about this for a period of 12 weeks, I probably would have terminated the pregnancy, now I have a wonderful child whose urine tests periodically deteriorate, this greatly affects the kidneys, he needs surgery in the future on the abdominal wall, due to cryptorchidism, as well as a heart defect, he has flat feet, he used to have clubfoot, but from the age of 2 weeks we put him in plaster according to the Panseti method, his legs improved, he behaves like a normal child, his teeth are also climbing, he sits down, gets up, walks, walks, well, in general, a wonderful baby, though he does it all with a delay of 3-4 months. I know a child with the same diagnosis as ours, he had an operation in England, collected about 4 million rubles, and everything seems to be fine with him, pah, pah, pah.
1. Our baby started to pee for a period of about 18 weeks (we thought that the bladder decreased from the fact that he began to pee, but it wasn’t there, a hole formed on the peritoneum from strong pressure, so the bladder returned to normal) we were immensely happy jumped and ran ... not for long.
2. At week 20, they discovered problems with the kidneys (bilateral hydronephrosis), but immediately said that it was being treated, they say, don’t worry
3. At 24 weeks, clubfoot was discovered (they said that everything would be fine, it even suits the boys)
4. At 28 weeks, cryptorchidism ...
The set of all these indicators is the Prune Belli Syndrome, but none of the uzists said this. So, I found information on the Internet that at 12 weeks someone was already told that the child had Prune Belli syndrome, the ultrasound specialist saw a thin wall of the abdomen in a child, no one saw us."

There are three main embryological theories for the occurrence of this syndrome:

Bladder outlet obstruction
This theory, proposed as early as 1903, was later substantiated by recreating the phenotypic changes characteristic of Prune Belly in case of obstruction of the urethra in the fetus of a sheep at a period of 43-45 days of gestation. According to this theory, all other changes are secondary. The absence of outflow of urine from the bladder leads to a significant increase in it, stretching of the anterior abdominal wall, disruption of its blood supply and atrophy, and also disrupts the process of testicular descent into the scrotum and leads to the formation of hydronephrosis and expansion of the ureters.
However, in humans, urethral obstruction in this syndrome occurs in 10-20% of cases. Some scientists believe that the obstruction may be passing, others argue that the obstruction occurs in the most severe forms of Prune Belly. According to human fetal embryology, such changes should appear at 13-15 weeks, since by this time the urachus begins to close and urine production by the fetus increases significantly.
Although this theory is quite convincing, it is not able to explain all the changes associated with Prune Belly.

The theory of mesodermal developmental delay
It is hypothesized that the urinary tract abnormalities may be explained by the abnormal development of the mesonephros between the 6th and 10th weeks. Changes in the development of the Wolffian duct lead to prostatic hypoplasia, delayed development of the prostatic urethra, and valve-like obstruction. However, this theory cannot include all the anomalies encountered in this syndrome.

Yolk sac theory
There is a hypothesis that in Prune Belly, the excess volume of the yolk sac may lead to anomalies in the development of the anterior abdominal wall, due to the involvement of most of the allantois in the formation of the urinary tract.

How to suspect Prune Belly syndrome during an ultrasound?

The first thing that catches your eye is megacystis, i.e. a significant increase in the size of the bladder, as well as a thin, stretched and protruding anterior abdominal wall. At 10-14 weeks of pregnancy, the diagnosis of megacystis is made when the longitudinal size of the bladder exceeds conditional standard 7 mm. With dimensions of 8-12 mm, in most cases, self-normalization occurs, but dynamic monitoring is required once every 2 weeks. This, apparently, is due to the fact that the formation of smooth muscle and innervation of the bladder does not end by the 13th week of gestation and continues in the following days, which gives rise to a self-resolution of the problem in the following weeks of intrauterine development of the fetus. Bladder enlargement, dilatation of the ureters, and pyelectasis can occur in megacystis-megaureter syndrome and posterior urethral valve, but in these conditions the amount of amniotic fluid usually remains normal, and there is no such thinning and protrusion of the anterior abdominal wall. The progression of megacystis and oligohydramnios are prognostically unfavorable signs that indicate obstruction of the outlet sections of the bladder.

It is not possible to unequivocally diagnose Prune Belly syndrome at 11-13 weeks, it can only be suspected, and the main diagnosis will be Megacystis, which, as I said, can be under various conditions.

What to do?

This is your child and the choice, as always, is yours to make. But sometimes, it is very important that someone take off, take on this burden of responsibility, the burden of choice that you have to make with your life, and not only with your life. It is very important to feel that only the best of decisions will be made here and now.
Here are the recommendations published in the article "Prenatal consultation by a pediatric urologist and decision-making tactics in the diagnosis of megacystis syndrome in the first trimester of gestation" http://www.lvrach.ru/2015/01/15436142/:
“Given that “megacystis” in 25–40% is combined with chromosomal pathology, the results of genetic studies play an essential role in making a decision on prolonging or terminating a pregnancy. Most authors agree that the valves of the posterior urethra, as well as prune-belle syndrome, are not a genetically inherited pathology, but this does not exclude the possibility of chromosomal damage. A. W. Liao states in 25% of cases the presence of trisomy on the 13th and 18th chromosomes with an increase in the size of the bladder from 7 to 15 mm in fetuses of 10-14 weeks of gestation.

The analysis of diagnostic measures and outcomes of the course of pregnancies made it possible to develop a diagnostic algorithm that implies mandatory karyotyping of fetal material in the presence of bubble sizes within 7–15 mm. When confirming a karyotype disorder, it is advisable to terminate the pregnancy, otherwise, dynamic observation until the appearance of convincing markers for the prognosis of the diagnosed condition.

A significant initial increase in the bladder ≥ 20-30 mm clearly indicates a severe obstruction of the lower urinary tract and does not require dynamic monitoring, it is advisable to terminate the pregnancy.

The presence of dilation of the upper urinary tract does not always complement the "megacystis" syndrome in the early stages of gestation (11-13 weeks) and is most clearly defined in the second and third trimesters of gestation. However, in all cases, its presence is a factor that aggravates the prognosis.
Thus, summing up the analysis of the literature data and the results of our own observations, several conclusions are obvious:

1. The complex of measures included in early prenatal screening at 11–14 weeks of gestation (molecular genetic and ultrasound markers of CM and CA) does not allow determining the likelihood of a urinary system in the fetus of CM. Identification of the risk group for fetuses threatened by the presence of congenital pathology of MVS occurs on the basis of the diagnosis of an increased longitudinal size of the bladder ≥ 7 mm, which is interpreted as fetal megacystis syndrome, and requires careful diagnostic measures to predict the outcome.
2. Fetal megacystis syndrome is considered as a manifestation of pronounced disorders of the urodynamics of the lower urinary tract of anatomical or functional origin, underlying the development of obstructive disorders of the upper urinary tract and dysplastic development of the renal parenchyma, including its cystic dysplasia, which predetermines decompensation of renal functions and an unfavorable outcome.
3. A set of diagnostic procedures that refine the prognosis when identifying a group of fetuses with megacystis syndrome includes karyotyping of fetal material (chorionic villi) in the absence of upper urinary tract dilatation and bladder size ≤ 20 mm and termination of pregnancy in cases of identified chromosomal pathology.
4. The presence of bladder enlargement ≥ 20 mm in isolation or in the presence of dilatations of the upper urinary tract is an indication for termination of pregnancy.
5. Prolongation of pregnancy is recommended in all cases of moderate expansion of the bladder within 7-15 mm in the absence of expansion of the upper urinary tract, positive dynamics of observation for 2-3 weeks, restoration of the size of the bladder.
6. Carrying out diagnostic measures and choosing tactical solutions should be carried out with the participation of a pediatric urologist, including the ante- and postnatal stage of dynamic monitoring and the necessary treatment.

- 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. Cortical and subcortical centers of the brain, centers of spinal innervation of the lumbosacral spinal cord, and peripheral nerve plexuses take part in its regulation. 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, a 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

If a child has urination disorders, 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 condition 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.

With 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 the volume of the bladder 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.

Fetal kidney stones are a very rare pathology. In an adult, on scans, they are defined as hyperechoic oval-shaped formations that give an acoustic shadow if their thickness exceeds 5 mm. In the fetus, due to the small size of cameos, acoustic leakage is never observed for them. On scans in the fetus, they are defined as oval-shaped hyperechoic formations, the length of which is usually 3-5 mm, the thickness is 2-3 mm.

The bladder of the fetus on scans begins to be detected at 12-13 weeks of gestation. On transverse scans, it is defined as round, and on longitudinal scans, it is defined as an echo-negative oval-shaped formation with clear, even contours, completely devoid of internal echo structures.

The size of the bladder is subject to significant individual fluctuations and depends on the degree of its filling. The emptying of the bladder occurs completely or fractionally, i.e. in parts. In some cases, in the amniotic fluid at the location, the appearance of a turbulent flow can be observed, the occurrence of which is due to the emptying of the bladder.

Anomalies of the bladder and urethra are rare. In the antenatal period, the following malformations of their development are mainly observed: bladder exstrophy, ureterocele, urethral atresia, posterior urethral valve, pmne-bUy.

Bladder exstrophy is a congenital disease characterized by a defect in the lower abdominal wall and the absence of an anterior bladder wall. This malformation is extremely rare - 1:45,000 newborns. In boys, this defect is often combined with total epispadias, and in girls, with anomalies in the development of the uterus and vagina. The main echographic sign of bladder exstrophy is the absence of its image on scans, while the size and structure of the kidneys remain normal.

The amount of amniotic fluid is also not changed. Diagnosis of exstrophy can be made as early as 16-18 weeks. Treatment is surgical only. Given the large number of unsatisfactory long-term results, the question of the advisability of continuing pregnancy should be decided jointly with specialists working in the field of pediatric urology.

Ureterocele is more often detected only at the end of pregnancy and mainly with a pronounced expansion of the ureter. Due to the fact that this pathology is almost always accompanied by pyelonephritis, urethritis and cystitis. in the immediate period after the birth of the child, it is necessary to refer to a specialized hospital for further examination and treatment.

Urethral atresia is an extremely rare malformation. The main echographic sign of this pathology is a pronounced increase in the bladder in the complete absence of amniotic fluid. An enlarged bladder begins to be detected from 14-15 weeks of pregnancy.

By the end of the II and the beginning of the III trimester of pregnancy, the bladder increases so much that it can fill the entire abdominal cavity. In turn, this leads to a significant increase in the abdomen.

In most cases, hydronephrotic transformation of the kidneys and dilatation of the ureters are noted with varying severity. With urethral atresia and bilateral severe hydronephrosis, termination of pregnancy is indicated.

A bladder diverticulum is a blindly ending protrusion of its wall. Diverticula can be single or multiple. The wall of the diverticulum consists of the same layers as the bladder, the muscular layer is hypoplastic. The pathogenesis is explained by the congenital inferiority of the muscle layer. On scans, it is defined as a small round or, less commonly, oval cystic protrusion of the bladder.

The disease is more common in male patients. Small asymptomatic diverticula usually do not require treatment, larger ones should be excised.

In most cases, this malformation reveals an enlarged proximal part of the urethra, which is depicted on scans as a small tubular structure located in the lower parts of the bladder. In many cases, megaureter and hydronephrosis are observed. Considering that the urethral valve causes intravesical obstruction, leading to severe urodynamic disturbance, and in most cases is accompanied by cystic ureteral reflux, termination of pregnancy should be considered appropriate in severe forms of the defect.

Prune-belly syndrome is a combination of anterior abdominal wall muscle hypoplasia, urinary tract obstruction, and cryptorchidism. It is manifested by hypotension and atrophy of the muscles of the anterior abdominal wall, a large atonic bladder, ureteral dilatation, and cryptorchidism.

The frequency of occurrence of the defect: one case per 40,000 newborns. In boys, it is observed approximately 15 times more often than in girls.

When diagnosing this pathology, it should be borne in mind that, unlike urethral atresia, amniotic fluid is determined in prune-belly syndrome. Ultrasound diagnosis of the syndrome is possible from the 15th week of pregnancy.

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 that these techniques are effective, there is no harm in using them, and it may even allow 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.

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.