In urology, there is such a disease as vesicoureteral reflux (PMR). This is a rather rare ailment, which is most often observed in children. However, pathology can also be detected in the adult population. Let's look at what the PMR is, why it is dangerous and what methods to deal with it.
Description of the disease
To understand what pathology is called vesicoureteral reflux, you need to go a little deeper into the anatomical structure of a person.
The bladder is a hollow muscle 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 enters from the kidneys into the bladder. The third hole is for emptying. This is the junction of the urethra with the bladder.
The ureters are funnel-shaped tubes. They enter the bubble at an acute angle. The ureters have a one-way specific valve system. It is she who prevents the reverse movement of urine into the ureter and further into the kidney. This is how 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 function. Accordingly, urine can move in one and the other direction. Thus, as a result of impaired outflow of urine, 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 even reach the kidneys.
Causes of pathology
The sources of the disease are not fully understood. Doctors associate vesicoureteral reflux in children with congenital abnormal development of this segment. Therefore, they are often diagnosed with primary pathology. This is an ailment manifested against a background of congenital anomalies.
Cystic-ureteric reflux in adults is secondary in most cases. The development of pathology is dictated by existing diseases.
The primary causes are:
- improper localization of the mouth of the ureter;
- bubble diverticulum;
- immaturity of the closing devices of the mouth;
- shortening of the submucous 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.
Secondary factors leading to the development of an ailment, as a result of which the normal outflow of urine is disturbed, include the following pathologies:
- infravesical obstruction;
- BPH;
- sclerosis of the neck of the bladder;
- cystitis in the area of the mouth;
- stenosis or stricture of the urethra;
- infectious diseases of the valves of the urethra;
- bladder dysfunction.
Disease classification
Pathology is divided into three varieties:
- Active PMR. Its appearance is dictated exclusively by the act of urination.
- Passive. It appears during the filling of the bubble.
- Mixed or passively active. A combination of the above conditions is characteristic of an ailment.
In addition, a pathology such as intermittent reflux is isolated. This disease manifests itself as a recurring 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:
- This species is characterized by the throwing of urine into the pelvic area of the ureter. At the first degree, the channel does not expand.
- Return outflow covers the entire ureter. In addition, there is a throwing of urine into the cup, pelvis. However, neither the canal itself, nor the departments of the kidney expand.
- For this degree, urine is thrown into the pyelocaliceal system of the kidney. The latter is expanding significantly. But the ureter does not change. Its diameter is normal.
- This stage is characterized by the expansion of both the pyelocaliceal apparatus and the ureter as a result of abundant urine reflux.
- At this degree, the functioning of the kidney is reduced. Such a clinic is dictated by the thinning of the department that produces urine.
Symptoms of the disease
Unfortunately, it is very difficult to detect vesicoureteral reflux at the initial stage. Symptoms of pathology are usually erased. That is why the disease is diagnosed most often when complications have already developed.
However, there is a certain group of signs by which it is possible to suspect the development of an ailment in children:
- underweight baby at birth;
- delay in physical development;
- bladder dysfunction.
In adults, vesicoureteral reflux manifests itself in a slightly different way. Symptoms that characterize the disease are usually as follows:
- urgent and often urge to urinate;
- pain discomfort in the abdomen or pelvis;
- a small amount of urine;
- the urine is cloudy, with a bad smell;
- during urination, a burning sensation appears;
- leakage of urine;
- the presence of blood in the urine;
- frequent night awakenings to go to the toilet;
- fever, chills;
- pain in the back, side 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, there is a deterioration in their main function - filtration.
As a result of reflux, a violation of the normal removal of urine occurs. Urine, containing microbial flora, freely penetrates the ureters and kidneys. Therefore, infection and inflammation are constantly observed in the organs.
In addition, during urination, pressure increases in the pelvis region. This leads to even greater damage to the kidney tissue.
Shrinkage 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, vesicoureteral reflux can be suspected. Diagnostics includes a number of examinations:
- Ultrasound
- Blood and urine tests.
- CT
- Cystourethrography. Liquid is introduced into the bladder through a catheter. Once it is full, a series of shots are taken. An x-ray is also performed during urination.
- Intravenous pyelogram. In this examination, fluid that is discernible in x-rays is administered intravenously. In this case, it is necessary to wait until the substance from the blood enters the kidneys and bladder.
- Nuclear scan. For the examination, various radioactive materials are used. They can be injected directly into the bubble or into a vein. This examination allows you to determine the degree of functioning of the urinary system.
Therapeutic measures
Only a doctor can determine a strategy to combat such a pathology as vesicoureteral reflux. Treatment is aimed at eliminating the cause of the disease and preventing complications.
The most serious consequence that can develop against the backdrop of an 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 disease and its severity.
Conservative treatment
This tactic is extremely effective in the early stages of the disease. Especially successfully treated is vesicoureteral reflux in children. In adult patients, improvement occurs in 70% of all cases.
The main objective of conservative therapy is the timely fight against infections involving the urinary system.
The treatment includes the following areas:
- Physiotherapy. Activities can eliminate metabolic disorders occurring in the bladder.
- Prescribing antibacterial drugs. They are prescribed for patients who are diagnosed with urinary tract infections.
- Compliance with the diet. Patients are necessarily recommended nutritional correction. Diet involves limiting the intake of protein and salt.
- Catheterization of the bladder.
- The use of antihypertensive drugs. Such medications are used if, as a result of the PMR, the patient's blood pressure rises.
- Regular urination is recommended. Such events must be carried out every 2 hours, regardless of the urge to the toilet.
If vesicoureteral reflux in children is suspected, treatment should occur in a hospital setting. Initially, the child is examined. Having determined the cause of the pathology, appropriate treatment is prescribed to eliminate the source of the disease.
In case of confirmation of a congenital anomaly, surgery is recommended for children.
Endoscopic surgery
This intervention is recommended if 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 the 1st, 2nd, 3rd degrees of the disease. And only if the contractile activity of the mouth remained.
This operation is minimally invasive surgery. It consists in the following. A special implant is inserted under the lower semicircle of the mouth. It allows you to close the upper and lower lip. As a result of this, the passive component of the antireflux mechanism is enhanced.
Surgery
Open operations are resorted to in the following cases:
- if neither conservative nor endoscopic treatment yields the necessary results;
- with pathologies of the 4th, 5th degree;
- in the case of congenital malformations in children that cannot be resolved by the endoscopic method.
Correction of vesicoureteral reflux is carried out in most cases on an open bladder. The main goal of surgery is the formation of a bladder under the mucosa, where the ureter is located, the necessary passage.
After such an operation, a certain barrier is created that protects the ureter and bladder from the entry of urine into them.
Surgical treatment provides excellent results, according to statistics, in 75-98% of all cases. However, surgery is not without drawbacks.
The disadvantages of the procedure are:
- prolonged anesthesia;
- long rehabilitation period;
- in case of relapse, repeated surgery is much more difficult.
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 away as the baby develops and grows. However, for this you need to protect the crumbs from exacerbations and infections. If such conditions are met, then in almost 10-50% of children, the pathology goes away on its own. But she is able to leave scarring changes on her tissues.
With PMR of grade 3 or higher, one should not rely on self-disappearance. Such children need adequate therapy prescribed by a doctor.
To prevent the development and progression of PMR, you need to:
- Timely treat all inflammatory diseases of the urinary system.
- Any violation of the act of urination requires a mandatory visit to a doctor.
- Pregnant women should definitely visit their doctor. In addition, a woman expecting a baby should adhere to a healthy lifestyle and proper, nutritious nutrition.
PMR is a very serious pathology. This disease must be treated in the initial stages, preventing its progression. Therefore, be sure to contact competent specialists.