Bladder and ureter reflux in children and adults. Symptoms, Diagnosis, Treatment

In urology, there is such a disease as vesicoureteral reflux (PMR). This is a fairly rare disease, which is most often observed in children. However, pathology can also be found in the adult population. Let's analyze what the PMR is, what it is dangerous and what methods to fight it.

Description of the disease

To understand what pathology is called vesicoureteral reflux, it is necessary to go a little deeper into the anatomical structure of a person.

The bladder is a hollow muscular organ. It is designed to accumulate urine until the act of urination has occurred. The bubble has 3 holes. Two of them connect with the ureters. Through these channels, urine comes from the kidneys into the bladder. The third hole is intended for emptying. This is the junction of the urethra with the bladder.

Urethers are funnel-shaped tubes. They enter the bubble at an acute angle. Ureters have a one-way, specific valve system. It prevents the urine from moving back to the ureter and then to the kidney. So a healthy system functions.

If a person is diagnosed with vesicoureteral reflux, then the mechanism that protects the body from the reverse movement of urine does not work. Accordingly, urine can move in one and the other direction. Thus, as a result of the disturbed outflow of urine, the fluid accumulates in the bladder, and then is thrown into the ureters. This leads to stretching, deformation of the latter. In severe forms of reflux, urine can reach even the kidneys.

Causes of pathology

Sources of the disease are not fully understood. Physicians associate vesicoureteral reflux in children with congenital anomalous development of this segment. Therefore, they are more often diagnosed with primary pathology. This is an ailment manifested against the background of congenital anomalies.

Bladder ureter reflux in adults is secondary in most cases. The development of pathology is dictated by the existing diseases.

The primary reasons are:

• Abnormal localization of the ureteral orifice;
• Diverticulum of the bladder;
• Immaturity of the clamping devices of the mouth;
• Shortening of the submucosal tunnel of the intramural ureter;
• Pathological form of the mouth;
• Doubling of the ureter, as a result of which the channel is located outside the triangle of the bladder.

To the secondary factors leading to the development of the disease, as a result of which the normal outflow of urine is disturbed, the following pathologies are attributed:

• Infravesical obstruction;
• BPH;
• Sclerosis of the neck of the bladder;
• Cystitis in the mouth;
• Stenosis or strictures of the urethra;
• Infectious diseases of the urethra valves;
• Bladder dysfunction.

Classification of the disease

Pathology is divided into three varieties:

1. Active PMR. His appearance is dictated solely by the act of urination.
2. Passive. It appears during the filling of the bladder.
3. Mixed or passive-active. For the disease is characterized by a combination of the above conditions.

In addition, they separately distinguish such a pathology as intermittent reflux. This disease manifests itself as a recurrent pyelonephritis.

Degrees of pathology

The disease can be characterized by a different form of severity.

According to the course, the following degrees of vesicoureteral reflux are distinguished:

1. This species is characterized by throwing urine into the pelvic zone of the ureter. At the first degree, the channel does not expand.
2. The return outflow covers the entire ureter. In addition, there is a casting of urine in the calyx, pelvis. However, neither the canal nor the kidneys are expanding.
3. For a given degree, the urine is cast into the calyx-calcification system of the kidney. The latter is greatly expanded. But the ureter does not change. Its diameter corresponds to the norm.
4. For this stage, the expansion of the calyx and pelvic apparatus, and the ureter as a result of abundant casting of urine is characteristic.
5. With this degree, kidney function is reduced. This clinic is dictated by the thinning of the department that produces urine.

Symptoms of the disease

Unfortunately, it is very difficult to identify at the initial stage vesicoureteral reflux. Symptoms of a pathology, as a rule, erased. That is why the disease is diagnosed most often when complications have already developed.

However, there is a certain group of symptoms, according to which it is possible to suspect the development of ailment in children:

• Insufficient body weight of the baby at birth;
• Delay in physical development;
• Disturbance of the functioning of the bladder.

In adults, vesicoureteral reflux is manifested somewhat differently. Symptoms characterizing the disease are usually the following:

• Urgently and often there is a urge to urinate;
• Painful discomfort in the abdomen or pelvis;
• A small amount of urine;
• Urine cloudy, with a bad smell;
• During the urination there is a burning sensation;
• The course of urine;
• The presence of blood in the urine;
• Frequent nocturnal awakenings to go to the toilet;
• Fever, chills;
• Pain in the back, lateral ribs.

Complications of the disease

Bladder ureter reflux can lead to extremely negative consequences. This pathology often provokes secondary kidney damage. The organs are wrinkled, their main function, filtration, deteriorates.

As a result of reflux, there is a violation of the normal removal of urine. Urine containing microbial flora, freely penetrates into the ureters and kidneys. Therefore, the organs are constantly experiencing infection and inflammation.

In addition, during urination in the area of pelvis increases pressure. This leads to even more damage to the kidney tissues.

The wrinkling of the kidney and its sclerosis lead to the appearance of secondary hypertension. This pathology is extremely difficult to treat. In this condition, it is often necessary to remove the kidney with the ureter.

Diagnosis of the disease

With persistent pyelonephritis, it is possible to suspect vesicoureteral reflux. Diagnosis includes a number of surveys:

1. Ultrasound.
2. Analysis of blood and urine.
3. CT.
4. Cystourethrography. Through the catheter, a liquid is injected into the bladder. As soon as it is filled, a number of pictures are taken. X-rays are also performed during urination.
5. Intravenous pyelogram. At the given inspection the liquid which is distinguishable on X-ray pictures, enter intravenously. In this case, you need to wait until the substance from the blood enters the kidneys and the bladder.
6. Nuclear scanning. Various radioactive materials are used for the survey. They can be injected directly into the bladder or into the vein. This examination allows you to determine the degree of functioning of the urinary system.

Healing measures

Only a doctor can determine a strategy to combat such pathologies as vesicoureteral reflux. The treatment is aimed at eliminating the cause of the disease and preventing complications.

The most serious consequence, which can develop against the background of ailment, is reflux-nephropathy. Pathology is an inflammatory, destructive process that occurs in the kidney parenchyma.

The tactics of treatment depend on the cause of the ailment and its severity.

Conservative treatment

This tactic is extremely effective in the early stages of the disease. Especially successfully treated with vesicoureteral reflux in children. In adult patients, 70% of all cases occur improvement.

The main task of conservative therapy is to timely fight against infections that cover the urinary system.

Treatment includes the following areas:

1. Physiotherapy. The measures allow to eliminate metabolic disturbances occurring in the bladder.
2. Purpose of antibacterial drugs. They are prescribed to patients who are diagnosed with infections in the urinary tract.
3. Compliance with diet. Patients are recommended to correct the supply. Diet involves limiting the use of protein and salt.
4. Bubble catheterization.
5. Use of antihypertensive drugs. These medications are used in the event that as a result of PMR the patient's blood pressure rises.
6. Regular urination is recommended. Such activities should be done every 2 hours, regardless of the urge to go to the toilet.

If vesicoureteral reflux is suspected in children, treatment should be performed in a hospital setting. Initially, the child is examined. Having determined the cause of the pathology, the appropriate treatment is appointed, directed at eliminating the source of the disease.

If a congenital anomaly is confirmed, surgical intervention is recommended for children.

Endoscopic surgery

This intervention is recommended in the event that conservative treatment did not give the desired result, or with congenital pathology in children. However, endoscopic correction of vesicoureteral reflux is carried out exclusively at 1, 2, 3-rd degrees of the disease. And only if the contractile activity of the mouth is preserved.

This operation is a minimally invasive surgery. It consists in the following. Under the semicircle of the mouth, a special implant is inserted. It allows you to close your upper and lower lips. As a result, the passive component of the antireflux mechanism is strengthened.

Surgery

Open operations are resorted to in the following cases:

• If neither conservative nor endoscopic treatment yielded the necessary results;
• At pathologies of 4-th, 5-th degree;
• In the case of congenital anomalies in children, which can not be eliminated by the endoscopic method.

Correction of vesicoureteral reflux is carried out in most cases on an open bladder. The main goal of surgical intervention is the formation of a necessary passage under the mucous membrane of the bladder where the ureter is localized.

After such an operation, a certain barrier is created, protecting the ureter and the bladder from the intake of urine in them.

Surgical treatment provides excellent results, according to statistics, in 75-98% of all cases. However, surgical intervention is not without its drawbacks.

The disadvantages of the procedure are:

• Prolonged anesthesia;
• Long rehabilitation period;
• In the case of a relapse, a second operation is much more complicated.

Preventive actions

Can reflux disappear on its own? If the pathology is diagnosed in the child at the initial stage, then it can really go along with the development and growth of the baby. However, for this you need to save the crumbs from exacerbations and infections. If such conditions are met, then practically in 10-50% of children the pathology passes independently. But she is capable of leaving scar tissue changes on her tissues.

With DMR of the third degree or higher, one should not rely on independent disappearance. Such children need adequate therapy prescribed by a doctor.

To prevent the development and progression of DMR, you need:

1. In time, treat all inflammatory diseases of the urinary system.
2. Any violation of the act of urination requires compulsory medical attention.
3. Pregnant should always visit your doctor. In addition, a woman waiting for a child should adhere to a healthy lifestyle and proper, nutritious nutrition.

PMR is a very serious pathology. This disease must be treated at the initial stages, not allowing its progression. Therefore, always contact a competent specialist.