An enlarged bladder in a fetus. Megacystis in the fetus - what is it, the causes of the development of pathology. How does cystitis manifest?

Some women may experience unpleasant symptoms during pregnancy, indicating that the uterus has begun to put pressure on the bladder. In this case, the patient very often visits the toilet and feels pain in the lower abdomen. Let's see why this happens.

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Possibility of uterine pressure on the bladder

During pregnancy, the genitourinary system of a woman works with a double load, as it removes all unnecessary from the body not only of the mother, but also of her child. As a result, the calyces of the kidneys become wider along with the pelvis.

Can the uterus put pressure on the bladder? It usually occurs in the first and third trimesters of pregnancy. And there is an explanation for this:

• In the first weeks, the uterus is located in the pelvic area and there it begins to grow, creating pressure on neighboring organs.
• In the second trimester, the uterus rises higher into the abdominal cavity, and the bladder is slightly released, the pressure is relieved.
• In the third, the uterus enlarges, the grown fetus descends with its head into the pelvic area and pressure is again created on the bladder.

As the fetus grows, the uterus expands and compresses the bladder, forcing urine back to the kidneys. Because of this, it seems to the woman that the bubble is constantly full. In addition, the placenta secretes a hormone that causes spasms of the muscles of the urinary system, which increases pressure on the bladder itself.

Is there any reason for concern?

The uterus is ready for bearing the fetus from the very beginning. It begins to increase from the moment of fertilization. She needs enough space to properly position in the abdominal cavity, and she begins to put pressure on neighboring organs. If there is no inflammation, everything is limited only to frequent urges to the toilet. In the presence of inflammatory process a woman feels pain, and she needs to see a doctor to avoid complications.

Causes of pressure

Over time, the uterus is established in its permanent place and partially rises from the small pelvis. In this case, the bladder is slightly released, and the condition of the pregnant woman is normalized. In addition, addiction to the urge develops, and the woman feels good. But if there is pain in the pubic region, then this may be a pathology that needs to be identified:

• The most dangerous may be cystitis caused by pathogenic microbes. During pregnancy, they attack the weakened body of a woman and easily penetrate the genitourinary system, causing inflammation and swelling. The patient suffers from pain when urinating, the urine becomes cloudy.
• Another cause of pelvic pressure may be cystalgia. With it, there is no inflammatory process, and urine remains normal. Otherwise, the symptoms are the same as those of cystitis.
• In the later stages, overfilling of the bladder should be avoided, as this also causes increased pressure on the internal organs.

One way or another, but with any deviations from the norm, a woman should immediately contact her doctor. The presence of cystitis indicates the presence of an infection in the body, which can harm not only the woman's body, but also interfere with the proper development of the fetus.

Symptoms of increased pressure in the pelvis

During pregnancy, a woman experiences high blood pressure in the pelvic area, which may be accompanied by such signs:

• Feeling of fullness in the abdominal region. There is a feeling of bloating.
• The urge to go to the toilet becomes very frequent, but very little urine comes out.
• In some cases, urinary incontinence may occur. This is due to the fact that under the action of progesterone (a hormone secreted by the female body during gestation), the sphincter (the valve that controls urine excretion) relaxes.
• The woman constantly feels discomfort, it seems to her that the bladder is not completely freed.
• Frequent constipation may occur. This is due to the fact that the uterus also presses on the intestines, as a result of which stagnation occurs in it.
• There is periodic pain in the lumbar region. It increases with exertion, with prolonged standing on the legs and with palpation of the abdomen.

These signs may not all be observed at the same time. The presence of at least one of them should alert a woman. Only a doctor can tell where is the pathology and where is the norm.

How to alleviate the condition?

The most dangerous pathology in a pregnant woman can be associated with cystitis. If it is detected, the doctor recommends a reduction in physical activity and the complete exclusion of sexual intercourse. Medications are prescribed, but with caution so as not to harm the developing fetus. For severe infections, antibiotics are prescribed. A special diet is prescribed. A pregnant woman is allowed to go out into the fresh air, but in no case be supercooled.

A pregnant woman should be registered as early as possible and be under the supervision of a gynecologist. She needs to be extremely attentive to her well-being and, in case of any deviations from the norm, immediately consult a doctor. If urination does not cause much concern, there is no pain and the color of the urine does not change, then there is no cause for concern. Frequent urges are provided by nature and are the norm.

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. Given that the urethral valve causes intravesical obstruction, leading to severe urodynamic disturbance, and in most cases is accompanied by vesicular 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.

And urethra is a rare occurrence. They can be detected during pregnancy with an ultrasound. If a defect is detected in the fetus, in most cases the pregnancy is terminated. Some anomalies are treatable and in this case it is important to monitor the size of the organ in question by week of pregnancy.

The bladder in the fetus: the formation and its size by week

The formation of the organ in the fetus begins on the 25-27th day of pregnancy. During this period, the urogenital sinus is formed from the internal germinal lobe. The final formation of the organ occurs when the fetus is at 21–22 weeks of development. The size norm is 8 mm. Anomalies of the urinary system in most cases occur due to diseases of the chromosomal type. The defects that appeared at the time of formation are presented below.

diverticulum

It is characterized by protrusion of the bladder wall. The main symptom is double urination. Pathology occurs due to the inferiority of the muscle layer. For treatment, surgical intervention is used, during which the diverticulum is removed. Congenital diverticula are more often single, less often there are 2 or 3. Emptying of urine from the diverticulum may be complete or incomplete. Small diverticula without symptoms do not require treatment.

Megacystis and hypoplasia

Megacystis is an increase in the size of the fetal bladder.

Megacystis is a defect in which the bladder is enlarged. A timely examination will make it possible to make this diagnosis at the initial stages of pregnancy and to detect an enlarged organ in time. With megacystitis, urinary is more than the standard norm. This anomaly may indicate the presence of cropped belly syndrome, which most often has a poor prognosis. To start treatment, diagnosis is used - vesicocentesis. This is an analysis of fetal urine, which is taken during a puncture of the bladder wall. Early vesicocentesis reduces the risk of fetal loss.

Hypoplasia is characterized by congenital reduction of the bladder, often with renal insufficiency. Very often this pathology is confused with agenesis. The capacity of the organ is several milliliters, which from the moment of birth is manifested by urinary incontinence. Depending on the situation, plastic surgery or cystostomy is performed.

Exstrophy, atresia and agenesis

Exstrophy is more common in males than in females. It is characterized by the absence of the anterior abdominal wall of the bladder or its defect. Exstrophy on the echographic picture is manifested by the absence of the bladder on the scan, while the structure of the kidneys remains normal, without changes in the amount of amniotic fluid. Treatment is carried out only by surgery.

Urethral atresia is a rare malformation in which the main indicators are enlargement, distension of the bladder, and lack of amniotic fluid. The bladder of the fetus can enlarge so much that it leads to an increase in the abdomen. With this pathology, termination of pregnancy is indicated; if it is maintained, in most cases a dead child is born or severe pulmonary hypoplasia is observed.

Agenesia is an extremely rare anomaly and is characterized by the absence of organ development. The birth rate with this pathology is very low. This disease is usually accompanied by other defects incompatible with intrauterine life. In newborns, the function of urination is preserved, but there is a constant partial retention of urine, and palpation reveals a distended bladder.

The bladder is hollow internal organ a person who performs the function of collecting and removing urine from the body. Its dimensions depend on the degree of fullness and may vary. The capacity of the bladder in women is slightly less than in men, on average it varies from 200 to 500 ml. However, sometimes the size of this organ changes - an enlarged bladder occurs.

enlarged bladder causes

On examination, an enlarged bladder may be perceived as a cyst, intestinal volvulus, or abdominal tumor. In order to exclude an error, before examining patients with urinary retention, they undergo catheterization of the bladder, as well as a rectal examination of the posterior wall of the bladder.

An enlarged bladder is one of the symptoms of urological diseases (for example, hydronephrosis, ischuria - urinary retention), therefore, a number of studies are carried out to clarify the diagnosis: chromocystoscopy, excretory urography, cystoscopy.

Megacystis in the fetus

In addition, an enlarged bladder occurs in children during fetal development. As a rule, the diagnosis of megacystis is made in early pregnancy. This anomaly occurs in 0.06% of fetuses. An enlarged bladder (or, otherwise, megacystis) is said to be when its longitudinal size exceeds 8 mm.

Megacystis in the fetus - causes

Most often, megacystis is a sign of an obstructive urinary tract lesion. Also, an enlarged bladder can signal cropped belly syndrome. The prognosis for this disease is poor in most cases. It is possible to diagnose it, starting from the second trimester of pregnancy. As a rule, if this diagnosis is established for medical reasons, the pregnancy is terminated.

Megacystis in the fetus - treatment

However, sometimes an enlarged bladder can be transient. In a number of cases (from 5 to 47 in different researchers), the bladder spontaneously returns to normal size. As a rule, in these cases, the perinatal outcome is favorable.

If an enlarged bladder is diagnosed in a fetus in early pregnancy, an additional examination is sometimes performed - vesicocentesis. This is a puncture in the wall of the bladder of the fetus. Thus, his urine is obtained for analysis. This study is carried out in cases of malformations of the urinary system and a number of serious diseases. In addition, statistics show that the loss of fetuses with megacystis during vesicocentesis in early pregnancy is significantly reduced.

– functional disorders 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, 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

Neurological disorders underlie the neurogenic bladder in children different 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 micturition 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 chronic inflammation 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, lemongrass), 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.