Bladder and ureter reflux - Causes, symptoms and treatment. MF.

Bladder ureter reflux is a disease that is characterized by a reverse transfer of urine from the bladder to the ureter.

Causes of vesicoureteral reflux

To date, the exact cause of urine backfilling from the bladder has not yet been clarified. Naturally, the direct factor is the failure of the ureteral sphincter, but it is much more important to know the primary cause, since it is her treatment that can prevent the development of the disease.

Many works are devoted to the study of the significance of chronic inflammation in the pathogenesis of vesicoureteral reflux. Despite the fact that a single opinion of urologists on this issue is still missing, many experts still tend to the idea that it is chronic salpingitis or pyelonephritis that is the cause of the pathology.

We can not exclude the congenital factor in the development of the disease in children. In particular, it has been proved that a variety of anomalies in the development of the muscular membrane and the nervous apparatus of the ureter are the most important etiological factors in the development of vesicoureteral reflux.

The most common disease occurs in those patients who have the two above-mentioned causative factors. When layering the infection on the abnormality of the ureter, the risk of vesicoureteral reflux increases several times.

It is impossible to exclude such etiological factor as urolithiasis. This is especially true when it comes to the presence of large or medium sized stones that can damage the muscular membrane of the ureter, leading to a violation of neuromuscular transmission and the formation of vesicoureteral reflux.

Symptoms of vesicoureteral reflux

There is no specific clinical picture for vesicoureteral reflux. As a rule, patients turn to a specialist only in the presence of complications. For example, the most common complication of vesicoureteral reflux is acute pyelonephritis, which is manifested by pain in the lumbar region and symptoms of intoxication, such as general weakness, malaise, head whips and insomnia.

Along with this, the disease is very often accompanied by an increase in blood pressure. Patients complain of constant headaches, mainly in the occipital region. This symptom can also be accompanied by flashing "flies" before the eyes and dizziness, which, in some cases, ends even with a loss of consciousness.

Degrees of vesicoureteral reflux

If a patient has these symptoms, he should immediately seek help from a urologist. Diagnostic tests appointed by the specialist will help to diagnose correctly and choose the optimal treatment tactics.

Diagnosis of vesicoureteral reflux

The general analysis of urine, as a rule, does not deviate from the norm. An exception can be called those cases when due to vesicoureteral reflux an inflammatory process develops. In such a situation in the patient's urine, an increased number of leukocytes, red blood cells and kidney epithelium can be found.

The only effective method for verifying the diagnosis of vesicoureteral reflux is mictorial cystography. It consists in the introduction of a contrast agent through the urethral catheter into the bladder cavity and in the radiographic examination of the pelvic area. With this pathology in the picture, one can see a cast of contrast from the bladder cavity to the ureters.

Mictorial cystography: vesicoureteral reflux

Ultrasound examination and other methods of diagnosis of diseases of the genitourinary system, as a rule, with reflux are not effective. Mikstatsionnaya cystography, due to its low cost and ease of implementation is carried out in virtually any surgical or urological hospital.

In addition, it is necessary to note cystoscopy, which can also be effective in the diagnosis of vesicoureteral reflux. When examining the mucous membrane of the bladder with a special optical device, it is possible to detect retrograde flow of urine into the ureter. It is noticeable how the valve of the latter does not completely close with peristaltic contractions of the bladder.

Treatment of vesicoureteral reflux

As a rule, patients in the initial stage of the disease are assigned expectant management, which consists of periodic examinations by the urologist and regular cystoscopy to identify the progress of the disease. In the absence of progression and the normal clinical condition of the patient, it is possible to refuse to conduct an operative intervention. In those cases where there is a pronounced clinical picture of the disease or a development of complications, the operation is simply necessary.

The objective of surgical intervention is to eliminate vesicoureteral reflux by forming a new ureter valve. To date, many methods of conducting such an operation have been proposed, but it is impossible to single out the only effective one. The most frequently used surgical intervention with the formation of a new valve by forming a duplicate mucosa. For this, from the outside, the ureter is stitched with an ordinary capron thread in such a way that, after tying the knot, a protrusion projecting into the lumen of the organ is formed. Strictly speaking, this fold is a valve that will prevent the urine from getting back from the bladder to the ureter.

The most modern method of correction of this pathology is suturing the artificial ureter valve, but in our country it is performed extremely rarely because of the high cost and the need for a large arsenal of newest equipment.

Rehabilitation after illness

Rehabilitation should be directed, first of all, to the prevention of relapse of the disease. For this, it is necessary to put a urethral catheter in the bladder cavity to urinate from it in time, and intravesical pressure did not rise.

In addition, the prevention of infection is extremely important, since the disease, in most cases, is associated with an inflammatory process. Patients are given broad-spectrum antibacterial drugs from the group of cephalosporins and aminoglycosides. Ceftazidime and ampicillin are sufficient to not only prevent secondary infection, but also cure pyelonephritis, which may be a possible cause of vesicoureteral reflux.

In addition, in urological practice, physiotherapy methods such as magnetotherapy and darsonval are often used. The purpose of their application is not only the early healing of the postoperative wound, but also the improvement of neuromuscular transmission in the synapses, which plays a very important role in the contractile activity of the ureter and prevents the development of relapses of the disease.

Features of nutrition and lifestyle

There are no specific recommendations regarding the diet. Patients can consume almost any food.

As for the lifestyle, it is somewhat complicated by wearing a urethral catheter for about one month after the operation. Patients should be taught how to properly change the catheter and regularly inject antiseptic solutions into the bladder cavity. As the latter, furacillin and chlorhexidine may be used. Getting into the bladder cavity, they decrease microorganisms in the area of ​​ureteropausal anastomosis, thereby preventing the latter from failing.

Treatment with folk remedies

As already mentioned, patients are treated for treatment, most often at the stage of complications, when radical methods should be used. If this time is spent on useless treatment with folk remedies, the disease can end with chronic kidney failure, which often has a lethal outcome.

Complications of vesicoureteral reflux

The most common complication of vesicoureteral reflux is acute pyelonephritis, which occurs due to the constant stagnation of urine in the cavity of the renal pelvis. As already mentioned, patients have complaints of worsening of the general condition and local pain in the lumbar region. In such a situation, it is necessary to conduct adequate antibacterial treatment so that the process does not end with a kidney abscess.

A more serious complication of vesicoureteral reflux is chronic renal failure, which can occur with severe forms of vesicoureteral reflux.

For the same reasons, there is a development of kidney stone disease, which is also accompanied by pain in the lumbar region, only they, in contrast to pyelonephritis, are not permanent, but periodic, intensifying with physical strain or trauma to the lumbar region.

The cause of hypertension is a violation of kidney function. Because of the constant stagnation of urine, a large amount of renin is compensatory, which is a potent vasopressor agent and, by reducing arterial vessels, leads to an increase in blood pressure. It should be noted that such arterial hypertension is very resistant to drug treatment, therefore, when correcting it, it is necessary first of all to eliminate vesicoureteral reflux, after which it is already engaged in lowering blood pressure.

Prevention of vesicoureteral reflux

First of all, for the prevention of vesicoureteral reflux, it is necessary to eliminate any inflammatory process of the urinary tract.

The second stage in the prevention of this disease can be considered prevention and treatment of urolithiasis, which can also act as an etiological factor of vesicoureteral reflux. All patients with this problem are given a diet with a minimum amount of salt. In the presence of large stones, surgical interventions can be excluded, which can be performed both laparoscopically and in an open way.

Forecast of vesicoureteral reflux

With timely diagnosis, correct and adequate treatment, the prognosis for life, recovery and performance is favorable.

Rev.the doctor the urologist, the sexologist-andrologist Plotnikov AN