Pioneros - purulent fusion parenhima kidney. Pioneros occurs when the kidney stones, complicated pyelonephritis (see), or as a result of progressive tuberculosis of the kidneys. Unlike infected hydronephrosis (see), while janefrose formed purulent cavities in the renal parenchyma, the inflammatory process goes to the pelvis, ureter and subsequent scarring and violations of the outflow of urine. Oral kidney filled with thick pus.
There are indoor and Pioneros. When you open janefrose of purulent cavities of renal parenchymal through the ureter into the bladder gets a lot of pus. When closed janefrose pus in urine misses the bladder, as the inflammatory process in the pelvis and ureter causes scarring of tissues, disruption of the flow of urine and expansion of the pelvis. The bladder with a closed janefrose comes clean urine of healthy kidneys.
The main signs of Pioneros are: Peoria (see), increased bumpy sedentary kidney, low-grade fever; the aggravation of Pioneros - high temperature, heavy pot. The diagnosis is based on data palpation kidney and special methods of research. During cystoscopy (see) shows that from the mouth of the ureter with the affected side pus. The use of excretory urography (see), retrograde pielografii (see) helps the diagnosis. However, if the closed janefrose these methods turn out to be useless. In such cases, the diagnosis helps percutaneous antegrade pielografia (introduction of a contrast agent into the pelvis by puncture) or diagnostic operation of exposure of the kidney (lumbotomy). If you suspect Pioneros patient should be hospitalized.
Treatment. Unilaterally janefrose shown nephrectomy (see), with bilateral - nephrostomy (see).
Pioneros (pyonephrosis; from the Greek. pyon - pus and nephros - Bud) - purulent fusion of renal parenchymal. P. may occur at stones of kidneys - calculous P.-either as a result of progressive tuberculosis of kidneys tuberculosis P. Banal P. rare.
The etiology and pathogenesis. The causative agent of Pioneros - various suppurative microbes: Staphylococcus aureus, Streptococcus, E. coli, and Mycobacterium tuberculosis. To identify the infected hydronephrosis (see) and P. wrong. When the infected hydronephrosis occurs before the stagnation of urine with the expansion of the pelvis and the thinning of the parenchyma, and then attaches the infection; P., on the contrary, as a result of pyelonephritis (see) appear purulent cavities in the renal parenchyma, and further inflammatory process in the pelvis and ureter causes scarring and disruption of the flow of urine with the expansion of the pelvis. The kidney is hilly with the centers tender, enlarged. On the cut - cavity with a thick pus, sealed walls covered with necrotic and granulation tissue; the wall of the pelvis sealed. The contents of the same infected hydronephrosis is cloudy urine mixed with pus. Phonerotica kidney surrounded by dense sclerotic cloth (chronic inflammation in fat and fibrous capsule kidney, ureter sklerosiruta, hope it decreases. Sometimes forms the so-called fat replacement kidney kidney permeated compacted fatty tissue. Pioneros mostly affects one kidney, but sometimes there is a bilateral P. Often with unilateral P. observed toxic jade in the doubles body. There are indoor and P. When the open item in the bladder comes copious amounts of pus. When closed, P. in the bladder urine comes without pus from the second contralateral kidney.
Over and symptoms. The main signs P. should be considered Juriy (see) and probing in the corresponding hypochondrium increased bumpy sedentary kidneys. Thermal response observed with acute infection or during the period of obstruction of the ureter. Often P. flows as a chronic disease fever with aching pain in the kidneys and General symptoms of intoxication (lack of appetite, dry mouth, etc.). Acute P. manifested by fever, chills, heavy sweating.
Complication of Pioneros is purulent parametric (see), which is observed in calculous P. when the stone forms a bedsore in the tissues of the kidney; in addition, infection of the kidney can go on okolopochechnuyu fibre and call it suppuration.
The diagnosis. Palpation region kidneys, supported cystoscopies installed allocation thick pus from the mouth of the ureter side enlarged kidneys, confirms the diagnosis of P. For more accurate forms of Pioneros, the degree of destruction of the kidneys and the decision of a question on the status of the second kidneys are special urologic research (chromatotherapy, catheterization ureters, panoramic radiography, excretory urography, retrograde pyelography). Function penetrationgay kidney sharply broken. Usually, the mucous membrane of the urinary bladder is not changed; sometimes the mouth hyperemic on the patient's side. The seal of the ureter is determined by the finger during vaginal or rectal examination; this characteristic is especially pronounced in tuberculous P. Some of the difficulties in the diagnosis of P. occur in closed form, even when retrograde pyelography is only a shadow of the ureter. In such cases, only during the operation can be distinguished from P. kidney tumors.
Treatment. Unilateral Pioneros successfully cured by nephrectomy (see Kidneys, surgery). Most surgeons believes primary nephrectomy surgery of choice. Nephrostomy is forced intervention; it is produced sharply weakened patients expressed General intoxication and exhaustion.
Due prerenalnaya sclerotic process nephrectomy sometimes difficult to perform and may be accompanied by damage of the pleura, peritoneum, intestines. So sick S. P. Fedorov offered to produce subcapsular nephrectomy. Thus cut through dense tissue around the kidney to her parenchyma, then easily stupid released by the kidney to her gate. For outcrops vascular legs and ureter turned sclerotic fabric cut in front and behind from a kidney at a distance of 1 to 1.5 cm from the gate and topferm move; thus vascular leg becomes available for the imposition of ligatures. Dissection sclerotic fabric down from the gate of kidney creates conditions for the selection of the ureter.
Pioneros - purulent-destructive melting kidney is most often found at stones of kidneys and ureters, advanced tuberculosis kidney or as the outcome of pyelonephritis.
When janefrose the size of the kidney is variable and depends on free or difficult outflow from her pus and urine. Kidney loose consistency, fluctuates during palpation. The pelvis is not extended, the walls of her sclerotic (fibrous).
In the context of kidney seen a number of cavities, separated by connective tissue walls. Wall cavities covered inside with granulations. Oral unevenly filled with pus, urine, and cellular debris, communicate with the pelvis. The wall of the pelvis inflamed and thickened (pielit, perepilet). When calculous and tuberculosis janefrose in kidney, respectively, are the stones or cheesy mass and caverns. In the miserable remnants of the renal parenchyma discovered phenomenon of chronic inflammation, sclerosis and fatty dystrophy.
In the inflammatory process usually involved fibrous and fatty capsules kidneys. Fibrous capsule thickened (perinephric), fatty tissue sclerotic (fibrous) and tightly fused with kidney (sclerosing parametric). Vascular leg buds infiltrated and thickened (pedunculate). The upper section of the ureter also thickened and sclerotic (fibrous) (ureteric, periartrit).
Patients complain of pain in the side, and General weakness, cloudy urine with thick, purulent sediment. The temperature is usually subfebrile or even normal. Periodically flank pain suddenly aggravated, the temperature rises to 40 degrees, urine becomes transparent, then in some days the temperature falls, flank pain subside, urine again becomes known. The aggravation associated with violations of the outflow of kidney pus and urine. By palpation kidney seems enlarged and sedentary by periplanarity and binding surrounding tissues.
During cystoscopy from the mouth of the corresponding ureter periodically allocated purulent urine. For Pioneros characterized by allocation from the mouth of the ureter thick pus, creeping in the bubble-like pasta, squeezed from a tube (Fig. 71). The affected kidney does not emit Indigo Carmine.
Fig. 71. The allocation from the mouth of the ureter thick pus.
Retrograde pyelography detects destructive changes of different nature and different degrees (extension of cups, eaten their contours additional cavity in the parenchyma of the kidneys).
Retrograde pyelography should be made cautiously. It is advisable to add to contrast fluid 50 000-100 000 UNITS of penicillin and to put it under a weak pressure.
The disease is chronic. Acute septic conditions alternate with temporary remissions, but exhaustion and cachexia progress. Toxic jade, growing in the second kidney, often goes in amyloidosis; hence the phenomenon of kidney failure, which is steadily increasing, and end with uremia.
The treatment is the removal of the kidneys.
In order to avoid injury to adjacent organs when janefrose often used subcapsular nephrectomy by S. P. Fedorov. Netscout fibrous capsule buds on convex its edge and finger inserted between the kidney and the capsule, the last throughout it is separated from the kidneys, and turn aside. To gain access to the blood vessels of the kidney and urinary tract, gently netscout fibrous capsule inside, the place commit it to the pelvis, stupidly separate capsule from the gates of the kidneys, allocate the ureter and renal vessels, tied up and crossed them, after which the kidney is removed (Fig. 72).
The General condition of the patient, especially if Pioneros accompanied by parametriem, the kidney is removed in two stages: first, impose renal fistula (first stage), i.e., drain the kidney, due to the outflow of pus from her, then, improvement of General condition, remove the kidney (second stage).
With bilateral janefrose treatment is bilateral nefro - or pyelostomy.
Fig. 72. subcapsular nephrectomy.
a - incision of the capsule inside; b - the retreat of the capsules and exposure renal legs and ureter.
