Among the diseases of the urinary system, vesicoureteral reflux occurs infrequently. Pathology mainly affects children and the elderly. Diagnosis is complicated by the absence of obvious symptoms at the initial stages of pathology.
What is vesicoureteral reflux?
Bladder-ureter reflux is usually referred to as a disorder in which the urine's reverse current occurs. Reflux of urine, transfer to the ureter and kidneys is carried out under pressure, which disrupts the operation of the valve of the vesicle of the ureter. This happens every time the bladder overflows, because of which, over time, there may be a change in the capacity of this organ.
Normally, the increasing pressure in the bladder as it is filling should cause the valve to close. However, with reflux, this formation is damaged or weakened, which causes a reverse urine current. The casting of urine can occur both during the act of urination and during the filling of the bladder. The disease for a long time does not manifest itself and is detected when examining the organs of the small pelvis.
Active vesicoureteral reflux
With this type of pathology, urine reflux occurs only during urination. The muscles of the bladder come to tone, as a result, the urine is poured into the ureters and further into the kidneys. Simultaneously, it is allocated to the outside. Thus the person feels some discomfort in the field of a loin, in sides. This form of pathology is due to the inadequacy of the valve located in the vesicle of the ureter, which is revealed during a comprehensive examination.
Passive vesicoureteral reflux
Passive reflux refers to the transfer of urine from the bladder to the ureters, which occurs during the period of filling the urine organ. With this form of pathology, the insufficiency of the valve is more pronounced, so the penetration of urine into the ureters and kidneys occurs constantly. The volume of urine returning back is due to the degree of impairment, the contractility of the bladder, and the condition of the valve itself.
Bladder / ureter reflux causes
Depending on the time of development of the disease, primary and secondary vesicoureteral reflux are isolated. The primary form of pathology is said when the disease is a consequence of congenital anomalies and is formed at the stage of intrauterine development - congenital vesicoureteral reflux. Increased pressure in the bladder with insufficient fixation of the ureteral orifice leads to a violation, causing urine reflux, the causes of which may be as follows:
- doubling of the ureter;
- dystopia of the mouth;
- gaping of the mouth;
- short submucosal tunnel of the intravesical ureter.
The secondary form of vesicoureteral reflux arises against the background of other pathological conditions of the urinary system. Among the common reasons:
- structure of the urethra;
- stenosis of the neck of the bladder;
- prostate adenoma;
- cystitis ;
- wrinkling of the bladder;
- damage to the ureteric orifice during surgery.
Chlamydial reflux symptoms
The symptomatology of the disease is often hidden. Of the possible, but not mandatory signs of the disease, doctors give out dull, aching pain in the lower back, which appear immediately after the bladder has been emptied. Children can point to pain in the lower abdomen, groin.
The signs of the disease are caused by the stage of the pathological process. Often, everything depends on the stage of development of vesicoureteral reflux, the degree of which can be as follows:
- 1 degree - urine returns to the ureter, does not reach the pelvis;
- 2 degree - the reflux reaches the kidney;
- 3 degree - the ureter dilates;
- 4 degree - the geometry of the urinary tract is disturbed, crimp appears;
- 5 degree - the parenchyma of points is thinned, all the above changes are present.
Complaints from patients doctors often hear often only with the development of pyelonephritis. In this case, there are observed:
- increased body temperature;
- stomach ache;
- deterioration of general well-being;
- clouding of urine.
In most cases, PMR is detected only at the stage of development of complications and other disorders, among which:
- recurrent cystitis (rapid urinary excretion in small portions);
- chronic pyelonephritis (aching, blunt character in the lumbar region, temperature no higher than 38 degrees);
- enuresis.
Bladder and ureter reflux - diagnosis
In the asymptomatic course for the diagnosis of vesicoureteral reflux, ultrasound of the kidneys should be used. The study can be conducted even before the baby's appearance (primary reflux). The indication for a complete urological examination may be an enlargement of the pelvis (in a transverse dimension greater than 5 mm). A comprehensive examination if there are suspicions of pathology should include the following studies:
- laboratory methods: general urine analysis, blood test, bacterial culture;
- radioisotope renography;
- dynamic nephroscintigraphy;
- uroflowmetry;
- excretory urography ;
- Mikrotsionnaya cystourethrography;
- cystoscopy.
Chlamydial reflux - treatment
To exclude vesicoureteral reflux, medical treatment is directed to the elimination of two damaging factors:
- hydrodynamic impact due to increased pressure in the bladder;
- recurrent urinary tract infections.
With any degree of disruption, therapeutic interventions start with conservative methods that include:
- Correction of metabolic disorders in the bladder and ureter (Pikamilon, Elkar).
- Prevention and treatment of infection of the genitourinary system - uroseptics , antibiotics, phytotherapy (Tetracycline, Metronidazole, Ciprofloxacin).
- Elimination of violations urodynamics.
Bladder-ureteral reflux - clinical recommendations
If the return of urine is due to the pathology of the ureteral orifice, the only way to treat it is surgery. In the course of it, restoration of the valve function of the ureter is carried out by transplanting the tissue and forming the valve by an artificial method. With secondary MTCT, correct treatment of the diseases that caused the disorder (urinary and urinary tract infections, bladder dysfunction) is required. The probability of the disappearance of the disease after the elimination of the causes can reach 70%.
Endoscopic correction of vesicoureteral reflux
In the absence of the effect of conservative therapy, when it is not possible to eliminate vesicoureteral reflux, the operation becomes the only method of therapy. Most often, the endoscopic method is used. Through the lumen of the ureters, without incisions on the skin, a gel implant is inserted into the ureteral region of the ureter. It forms a tubercle, which acts as a valve, preventing backward transfer of urine from the bladder into the ureter.