Vesicoureteral reflux in children and adults: symptoms, treatment
Medicine there are many pathologies that occur in the genitourinary system. One of the most common deviations is vesicoureteral reflux (VUR). The pathology is characterized by irregular work of the organs of the excretory system where urine from the bladder enters the urethra. In a healthy person it is not considered the norm, because the ureter connected to the bladder through zamechatelnogo mechanism that prevents urine in the kidneys and ureter. The disease occurs in adults and children, the latter are more susceptible to this disease. If not promptly diagnosed and do not affect the pathology, there will be complications: pyelonephritis or hydroureteronephrosis that will lead to dysfunction of the kidneys.
Ureteral reflux is a pathological condition which is more common in children. When the disease is the reflux of urine from the bladder to the kidney. This is because the sphincter that should prevent this deviation and to serve zamechatelnym valve, not until the end closes the mouth of the ureter. The reason for this lies in the inflammatory process, which was formed in the bladder.
To detect reflux of the bladder during urination, which will happen a difficult excretion of urine. Ureteral reflux leads to the accumulation of urine in the bladder, which allows harmful bacteria to multiply and provoke inflammation. In this deviation over time is observed scarring of the renal parenchyma and arterial hypertension. Reflux in the ureter leads to disruption of the structure of renal tissue, which causes for disorders of the kidneys.
Doctors klassificeret ureteral reflux in several ways. Depending on the disease there are passive, active and combined forms of reflux. Passive for urine to the kidney enters regardless of the process of urination. The active form is characterized by the release of urine into the ureter only when trips to the toilet. When passive, active or mixed type observed the ingress of urine into the ureter and kidneys in the process of emptying and independently.
There is a division of reflux of the ureter and kidney at the primary and secondary pathology. The first caused by defects in ureteric mouths and muscles of majevica that have to be congenital. Secondary reflux kidney and ureter occurs with inflammation, cystitis, pyelonephritis, and other abnormalities in the internal organs of the pelvis. This form often occurs after surgery.
Klassificeret reflux as to what time he appeared. So, in medicine distinguish between permanent and transient pathology. Constant reflux accompanies man throughout life and has chronic form. When a transient type of the pathology of intermittent and manifests itself in exacerbations of various diseases of urinary system. On the occurrence of transient reflux affects cystitis and acute prostatitis. When inflammation of the prostate gland in men is malfunction of the urinary system, which leads to stagnation of urine and its contact with the kidney.
The main causes in children and adults
Medicine still haven’t managed to explore all the sources that influence the occurrence of PMR. Pathology in childhood provoke abnormalities of a congenital nature, which negatively influenced the development of the internal organs of urinary system. In children, usually diagnosed primary pathology. Causes of primary reflux include:
- protrusion of the bladder;
- immature skateline apparatus of the mouth;
- misplaced ureteral mouth;
- a shortened submucosal tunnel of the internal division of the ureter;
- the abnormal form of the mouth;
- the location of the urinary canal outside the triangle of the bladder as the result of the doubling of the ureter.
In adults, doctors observe the pathology of the secondary type, which was preceded by various diseases of the organs of urinary system. To renal reflux can provoke cystitis, in which the inflamed mucosa of the bladder. Pathology occurs when there is an obstacle that does not allow normal urine output. Such obstacles are created in the adenoma of the prostate, stricture of the urethra, stenosis of the external opening of the urethra.
Urine reflux to the kidneys occurs with sclerosis of the neck of majevica, which is characterized by thickening of the walls of the internal organ, which prevents the excretion of urine.
Cause of secondary reflux is the impaired function of the bladder. It occurs when a hyperactive body of work, in which there is frequent urination, enuresis or persistent urination in the toilet. Often pathology provokes the reduction of the internal organ, which is observed in the case of wrinkling of majevica.
The extent of damage
When there is reflux of the ureter, it is the stretching of the renal pelvis-plating system. In this case there is a disruption in the functioning of the kidneys and other internal organs. Reflux of urine is divided into five degrees of flow. The first degree of pathology is the safest, while urine flows from the bladder into the secondary branch of the ureter. At the initial stage does not change the structure of the body and it is not expandable. At the second degree lesions the urine is thrown in the reverse order: it fully penetrates into the renal pelvis. Two initial stages in a child and adults do not need treatment, these patients are registered and doctors monitor the progression or attenuation of disease.
Third degree leads to expansion and thickening of the internal organ, but the diameter of the ureter remains unchanged. In the fourth stage, the person expands on the structure and it becomes convoluted, while there is enhanced renal pelvis. The last fifth stage, the most serious and dangerous, because in this case there is renal dysfunction that is associated with the depletion of the parenchyma of the organ.
As such the special features under reflux in a patient is not observed. Symptoms begins to appear in the case when the background of the PMR has developed complications. In this case the patient is having pain in the lumbar spine, which felt stronger after urination. There are signs of disease:
- bursting sensation in the kidneys;
- turbidity of urine;
- high body temperature;
- swelling of the limbs and face.
Typical reflux symptoms are spotting and foam in urine.
General condition of the patient deteriorates significantly, there is lethargy and painful. The patient’s blood pressure rises, if there are scarring in renal tissue. But not always, manifested symptoms or discovered fuzzy signs of the disease, therefore, if you notice suspicious symptoms should not self-diagnose and self-medicate.
Features of PMR in children
The child of this pathology is found more often than an adult and needs timely treatment. First and foremost, there is an increase in body temperature to 39 °C, which is very difficult to shoot down. This is often the first sign mistaken for the manifestation of cold and independently undertake curative measures. To determine reflux in children allow the following manifestations:
- cutting pain in the allocation of urine;
- the lag in the development;
- colic and pain in the abdomen;
- impurities in the blood and urination;
- deterioration of the General state of health.
Suspected pathology of the kidney in children can be up to 3 months of age, since when the reflux of the weight of a newborn baby is smaller than normal. When conducting x-ray inspection are the detected changes in the structure of the bladder. General analyses of urine and blood will show elevated white blood cell count. It is extremely important to detect abnormalities in the baby to start treatment early and avoid complications.
Possible complications and consequences
Because reflux often occurs without any symptoms, pathology can be detected when already having complications. The most frequent aggravation of PMR is pyelonephritis in the acute form. It causes constant congestion and the emission of urine in the renal pelvis and ureter. When such a deviation should promptly take action and treat the pathology with the help of antibiotics. Untimely detection and treatment of reflux will eventually lead to an abscess of the kidney.
Severe complication is kidney failure in the chronic form. This problem occurs in the last stages of reflux. In patients with a neglected disease there are kidney disease, which causes severe pain in the lower back. In the process of acute disease is arterial hypertension, the cause of which is renal dysfunction. Due to the frequent stagnation of urine begins to stand out a considerable amount of renin. It leads to a reduction in blood vessels, which provoke high blood pressure. This deviation could be very hard to cure, usually the problem can be solved only after elimination of the reflux.
Diagnosis of vesico-ureteric reflux
For pathology, you should consult a doctor-urologist and to pass a comprehensive diagnosis of the urinary system. First the doctor is interested in the concomitant symptoms and how long ago they occurred. If you have pain, it is important to find out the place of their localization, the nature and frequency of occurrence. Also important is the hereditary pattern of the patient and of the disease in children, which could affect the appearance of the pathology. In survey after survey the doctor prescribes to undergo the following investigations:
- General analysis of blood and urine. With this method, the survey confirmed the inflammatory process in the urinary system.
- Ultrasonic diagnostics of organs of urinary system, which highlights the changed size and structure of internal organs. With the help of ultrasound can detect tumors or stones.
- Excretory urography is carried out using contrast medium that is administered intravenously. This method determines the extent to which the violated the outflow of urine from the kidney.
- Uroflowmetry registers, the speed with which urine is excreted from the excretory system. With this technique will be a violation of the process of separation of urine.
- Meccinna cystourethrography, carried out with the help of the substance, which is revealed in the x-ray. The record at the time of allocation of urine that allows us to estimate the form of reflux and its stage.
The doctor prescribes the patient to undergo a cystoscopy where the bladder is injected optical device that allows you to inspect the mucosa of the body and the orifice of the ureter. A comprehensive survey is needed to identify the full picture of the disease to accurately select the treatment to eliminate the symptoms and the lesion.
Treatment: the main methods
Depending on the extent of damage, status of internal organs and the General health of the patient is prescribed different methods of treatment. In medicine reflux treated with conservative therapy, endoscopic surgery or surgery. Any of these methods aims to eliminate the unpleasant signs of the disease and its causes. Therapy should maximally reduce the possibility of relapse.
Conservative treatment is applied at any degree of reflux in the urinary system. Physiotherapy shown in the case, the required correction of metabolic disorders of internal organs. To infections in the urinary system, doctors prescribe the drugs with antibacterial effects. Recommended receiving funds, to enhance the immune system. In the conservative treatment included uroseptic remedies and herbal remedies.
To avoid pyelonephritis, use of the antibiotics that cure the violation in the process of excretion of urine.
If the patient has reflux 1-3 stage, conservative treatment in 75% of cases effectively cope with this problem. Children, as a rule, medicines that help in all cases. After treatment, the patient undergoes re-examination, which is carried out after six months or a year. If there is a recurrence, then surgical treatment is assigned.
In this method of treatment the patient is undergoing surgery by implantation of a substance which will fill the clearance in the valve mechanism so that urine does not leak into the ureter. When endoscopic therapy is used implants of heterologous materials. This method is less painful and allows a re-infestation. The disadvantage is the fact that it is impossible to process the transaction monitor how effective valve is created, whether it offset or degradation. In the event of a failed operation would require re-manipulation.
Surgical intervention is shown in the case when pathology has reached the final stages or if there is bilateral reflux. In this case, the patient is sent to surgery, which involves the creation of an effective valve, not passing urine. In most cases, the surgeon makes a new valve, forming a double mucosa. The doctor stitches the inner on a nylon thread from the back side, the result of tying the knot, which emerges through the lumen of the organ. The resulting crease plays the role of a new valve that holds the urine and does not allow her to enter the ureter.
Prognosis and prevention
In the case of the defeat of the first degree and in the absence of pyelonephritis is the outcome for the patient is favorable. In most cases the patient fails to fully recover and avoid serious consequences. In severe reflux (4-5 degree) often found sclerosis of renal parenchyma, which causes scarring or impaired development of tissues of the body. A patient is put on the account and had regular blood tests and to undergo antibiotic therapy.
To avoid these complications and the disease itself, it should not neglect preventive measures. The first manifestations of inflammatory processes in the urogenital system immediately contact your doctor and treat the pathology. When there is a difficulty in excretion of urine, the necessary consultation and examination the urologist. Men aged 45 years and older regularly examine the prostate, in order to avoid inflammation and tumors.