How is vesicoureteral reflux treated?

When choosing a treatment plan for vesicoureteral reflux and its complications, a thinly differentiated approach is needed, since surgery on a relatively immature vesicoureteral segment can interrupt the natural maturation process and affect the functions of the urinary system in the future. In addition, differential diagnosis of the causes of reflux (developmental defect, morpho-functional immaturity or inflammation) is difficult, which is especially characteristic for children under three years old.

But it must be remembered that treatment of vesicoureteral reflux follows from the time of pathology. Indications for surgical treatment of vesicoureteral reflux are considered to be vesicoureteral reflux of grade 3 with ineffectiveness of conservative therapy for 6-12 months; vesicoureteral reflux of 4-5 degree.

The main principles of therapeutic treatment of vesicoureteral reflux is the prevention of infectious diseases of the urinary system, correction of the concomitant pathology of the urinary system, physiotherapy, prevention of sclerosis of the renal tissue, membrane stabilizing therapy.

In the conservative treatment of vesicoureteral reflux, it is necessary to take into account the background on which this condition occurs. So, with the development of pyelonephritis, a longer additional course of uroseptics is needed.

With the development of vesicoureteral reflux on the background of a neurogenic bladder, it is advisable to carry out measures aimed at correcting the neurogenic bladder.

With neurogenic dysfunction of the urinary bladder by hyporeflective type it is recommended:

• a mode of compulsory urination (in 2-3 hours);
• bath with sea salt;
• course adaptogens (ginseng, eleutherococcus, lemongrass, zamanicha, rhodiola rosea, golden root, 2 drops of tincture for a year of life in the morning);
• glycine orally 10 mg / kg per day. Within a month;
• physiotherapy: electrophoresis with proserin, calcium chloride; ultrasound on the urinary bladder; stimulation of the bladder.

With neurogenic dysfunction of the bladder, it is advisable to carry out the following measures on the hyperreflective type:

• preparations of valerian, peony root, motherwort;
• preparations of belladonna (belloid, bellataminal);
• pantogam orally to 0.025 mg 4 times a day for 2-3 months;
• picamilon 5 mg / kg per day. For 1 month.
• physiotherapy: electrophoresis on the bladder area of atropine, papaverine; magnetotherapy (UHF-DKV); ultrasound on the urinary bladder; electrostimulation of the bladder by a relaxing technique.

With vesicoureteral reflux, to improve the contractile activity of ureters, the appointment of dynamic currents to the ureteral region in the amount of 10 procedures is recommended. The rhythm of syncope is prescribed for 7-10 minutes. The course of physiotherapy is repeated after 1.5 - 2 months. 3-4 times.

For the prevention of sclerotherapy of the kidney tissue, the use of riboxin, stugerone is recommended. From the membrane stabilizing drugs used vitamin B ₆, vitamin E.

The development of reflux-nephropathy at any degree of PMR is an indication for performing surgical correction of reflux.

Before the intervention, it is necessary to conduct a course of antibiotic therapy to prevent the manifestation or exacerbation of the pyelonephritic process.

With the development of reflux-nephropathy in the pre- or postoperative period, it must be taken into account that this condition occurs against the background of violations of cellular energy of various degrees. Therefore, all children are recommended to use succinic acid preparations (yantovit, mitamine) at 25 mg / day, and in the presence of data on the violation of mitochondrial enzyme activity - the use of an extended treatment regimen using drugs that are aimed at correcting the state of mitochondria. When developing nephrosclerosis, it is advisable to use antisclerotic drugs (vitamin B ₁₅, solcoseryl, stugeron, cytochrome C).

The main drugs used in complex treatment in the presence of signs of mitochondrial insufficiency

Name of the drug	Introduction	Dosages	A course of treatment
Yantovit	Per os.	25-50 mg / day	1 -1.5 months. Three days in three days
Mini yantovit	Per os	See No. 1	Also.
Mitamin	Per os	See No. 1	Also
Elkar	Per os	50-100 mg / kg.	Zme.
Coenzyme q10	Per os	30-300 mg / day.	Zme.
Riboflavin	Per os	20-150 mg / day.	1 month
Thiamine	Per os	50 mg / day.	1 month
Pyridoxine	Per os	2 mg / kg / day.	1 month
Lipoic acid	Per os	50-100 mg / day.	1 month
Vitamin E	Per os	100-200 mg / day.	1 month
Dimephosphon	Per os	15-20 mg / kg	1 month
Vitamin B	Per os	100 mg / day ..	1 month
Cytochrome C	B / m; B / in	20 mg / day.	10 days
Solcoseryl	B / m	2 ml / day.	2-3 weeks.

Conservative treatment should be carried out under constant monitoring of the child's condition with the help of laboratory and instrumental studies (general and biochemical analysis of urine and blood, urine enzymes activity, urea and blood creatinine levels, ultrasound and dopplerographic examination of the kidneys, cystography, cystoscopy, intravenous urography and radioisotope study of the kidneys ).

Dispensary supervision

Children with vesicoureteral reflux and reflux nephropathy should be observed with the nephrologist before transferring to an adult network.

Dispensary observation includes:

• examination by a nephrologist at least once every 6 months;
• control of urine tests 1 time per month. And with intercurrent diseases;
• the general or common analysis of a blood 1 time in 3 months. And with intercurrent diseases;
• biochemical blood test with mandatory determination of the level of urea and creatinine 1 time per bm;
• biochemical analysis of urine 1 time per bm;
• analysis of mitochondrial enzyme activity once a year;
• analysis of urine enzyme activity once a year;
• cystography after the course of therapeutic treatment, then 1 time in 1-3 years;
• cystoscopy according to indications;
• Ultrasound and dopplerography of the kidneys 1 time per bm;
• radioisotope study of the kidneys 1 time per year;
• intravenous urography according to indications;
• angiography of the kidneys according to the indications.

Prevention of the development of vesicoureteral reflux and its complications is as early as possible its diagnosis. This requires an antenatal ultrasound with a degree of pyeloectasia, as well as ultrasound of the kidneys in the neonatal period and in the first year of life.

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