How does the antireflux mechanism work?
The ureter does not enter the wall of the bladder at a right angle, but passes some distance inside the wall itself - this area is called the submucosal tunnel. When the bladder fills and especially when it contracts during urination, the pressure presses the walls of the tunnel against each other and closes the lumen.
If the tunnel is too short, the orifice is not positioned correctly, or the muscle support is weak, the valve will not operate. Urine under pressure goes up - reflux occurs.
There are primary reflux associated with congenital valve failure, and secondary, arising due to high pressure in the bladder: with a neurogenic bladder, prostate adenoma, urethral stricture, cervical sclerosis. This is important because with secondary reflux, the cause of high blood pressure must be treated first.
Degrees of reflux
- I degree - reflux only into the ureter, without dilatation
- II degree - casting reaches the pelvis and calyxes, there is no expansion
- III degree - moderate dilation of the ureter and pelvis
- IV degree - pronounced dilatation, tortuosity of the ureter, smoothness of the calyx arches
- V degree - sharp expansion and tortuosity, gross deformation of the pyelocaliceal system
Symptoms
- Often there are no symptoms - reflux is detected during examination after an episode of pyelonephritis
- Recurrent urinary tract infections
- Episodes of high fever without catarrhal symptoms, especially in young children
- Lower back pain that gets worse during or immediately after urination
- In children - restlessness when urinating, poor weight gain, growth retardation
- Increased blood pressure with reflux nephropathy
- Biphasic urination: immediately after voiding, the urge appears again
Why is reflux dangerous?
- Recurrent pyelonephritis
- Reflux nephropathy - scarring of kidney tissue
- Kidney shrinkage and loss of function
- Arterial hypertension of renal origin, including in young people
- Chronic kidney disease with bilateral damage
- Complications of pregnancy in women with reflux nephropathy
Key Point: It is not the urine reflux itself that damages the kidney, but the combination of reflux and infection. This is why infection prevention is a central part of treatment at any stage.
Diagnostics
- Victory cystourethrography is the main method that allows you to see the reflux and determine the degree of
- Ultrasound of the kidneys and bladder with assessment of the thickness of the parenchyma and the volume of residual urine
- Static nephroscintigraphy - reveals scars in the kidney
- Dynamic nephroscintigraphy - evaluates the function of each kidney
- General analysis and urine culture
- Blood creatinine
- Urodynamic study for suspected neurogenic dysfunction
- Cystoscopy to evaluate the ureteric orifices
- Measuring blood pressure over time
Treatment
- Observation with infection prevention - for low grades in children, since reflux often disappears with age
- Antibacterial prophylaxis in low doses as prescribed by a doctor
- Normalizing the rhythm of urination and treating constipation is an underestimated but effective measure
- Treatment of bladder dysfunction, if present
- Elimination of the cause of high pressure in the bladder during secondary reflux: prostate adenoma, urethral stricture, cervical sclerosis
- Endoscopic injection of a volume-forming substance under the orifice of the ureter is a minimally invasive method
- Ureterocystoneoanastomosis - reimplantation of the ureter with the formation of a new anti-reflux tunnel; performed openly or laparoscopically
- Dissection of the ureteral orifice for associated anomalies
- Removal of a non-functioning kidney - in rare cases, if it is completely shriveled and there are complications
Observation
- Regular urine tests, especially during any episode of fever
- Ultrasound of the kidneys with assessment of growth and thickness of the parenchyma
- Blood pressure control
- Creatinine control
- Repeated cystography to assess dynamics as prescribed by a doctor
- Examination of siblings of a child with reflux - the disease has a hereditary predisposition
- Observation in women with reflux nephropathy when planning pregnancy
Where they are examined and treated in Tashkent
Diagnosis requires cystography and assessment of renal function, and for the treatment of high degrees, surgery with the formation of an antireflux mechanism.
In Tashkent, examination and surgical treatment of vesicoureteral reflux, including open and laparoscopic ureterocystoneoanastomosis, is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If the child had pyelonephritis with a high temperature, be sure to complete the examination with cystography: this is how reflux is detected, which otherwise will go unnoticed until scars appear in the kidney. Clinic contacts are below.
