Symptoms of vesicoureteral reflux

Symptoms of vesicoureteral reflux are non-specific. Identified urinary infection, pyelonephritis, arterial hypertension, renal failure in many cases are complications of vesicoureteral reflux. Clinical symptoms of complications of vesicoureteral reflux should alert the doctor: it is necessary to find out the cause of their occurrence.

The most common symptoms of vesicoureteral reflux are pain that occurs during or immediately after urination. In young children, the pain is usually localized in the abdomen, while in older patients, it is pain in the lumbar region. One of the main symptoms of vesicoureteral reflux is unexplained hyperthermia without catarrhal symptoms of the upper respiratory tract. Often, the symptoms of concomitant urological diseases come first: cystitis (frequent painful urination), pyelonephritis (constant dull pain in the lumbar region), exacerbation of enuresis, etc. With a correct assessment of the entire symptom complex of the disease, the doctor may suspect vesicoureteral reflux and begin the necessary urological examination of the patient.

Types of Vesicoureteral Reflux

It has been proven that vesicoureteral reflux is a pathological condition with polymorphic etiology. According to the generally accepted etiological classification, vesicoureteral reflux is divided into primary and secondary. Primary (congenital) vesicoureteral reflux is associated with dysplasia of the vesicoureteral junction, shortening of the intramural section of the ureter, dystopia of the orifice, or a combination of the above. The etiology of secondary vesicoureteral reflux may include both congenital and acquired conditions: inflammatory diseases of the bladder, neurogenic dysfunction of the bladder and vascular insufficiency, iatrogenic damage to the vesicoureteral junction, bladder wrinkling, pregnancy.

Based on cystography data, a distinction is made between passive and active reflux. Passive vesicoureteral reflux occurs when the bladder is filled with a contrast solution and at rest after it is filled. It is important to remember the age-related norms for bladder capacity, since overfilling the latter leads to the creation of unnatural conditions and disruption of the vesicoureteral valve locking mechanism with the occurrence of reflux (false positive result). Active vesicoureteral reflux occurs during urination and is associated with an increase in hydrostatic pressure inside the bladder. Under normal conditions, the ureteral orifice ("vesicoureteral valve") is able to withstand pressure from the bladder up to 60-80 mm Hg.

The International Cystographic Classification was most widely used in 1985. The authors recommended distinguishing five degrees of vesicoureteral reflux:

• I - the pelvic part of the ureter is contrasted.
• II - vesicoureteral reflux is observed throughout the entire ureter and collecting system of the kidney.
• III - the contrast agent reaches the renal pelvis and calyces, expanding the latter.
• IV - dilation of the ureter and renal pelvis-calyceal system is recorded.
• V - massive vesicoureteral reflux with pronounced dilation of the ureter and renal pelvis and calyces (knee-shaped bends of the ureter, renal parenchyma is sharply thinned).

Taking into account the clinical course of the disease, transient and permanent forms of vesicoureteral reflux are distinguished. Low cystographic degrees and moderate degree of renal dysfunction are more typical for the transient form. As a rule, transient reflux is detected during exacerbation of intercurrent diseases (cystitis, pyelonephritis, vulvitis).

In recent years, there has been a justified classification of vesicoureteral reflux depending on the degree of impairment of the secretory function of the kidney. According to this classification, three degrees of vesicoureteral reflux are distinguished.

• Grade I (moderate) corresponds to a decrease in kidney function of up to 30%.
• II degree (moderate) – decrease in function up to 60%.
• III degree (high) - more than 60%.

Thanks to this division of the degree of vesicoureteral reflux, the type of treatment for this disease is largely determined.