Vesicoureteral reflux: an overview of information

Bladder and ureter reflux is one of the most common diseases of the urinary system, especially in children.

[1], [2], [3], [4], [5]

Epidemiology

The prevalence of the disease in the child population is 1-2%. Among children with infection of the urinary system, vesicoureteral reflux is detected in 50-70% of patients. In the first year of life, the ratio of boys and girls suffering from this disease is 6: 1, and this ratio varies for girls in the younger school age.

At the same time, many authors share the view that the true figures of occurrence in the population remain undiagnosed and underestimated for reasons of invasiveness of diagnostic measures. Approximated to true frequency figures can be obtained by revealing an asymptomatic primary form in siblings, patients with vesicoureteral reflux. Thus, the prevalence of the primary form of the disease among siblings in a number of studies ranges from 4.7 to 50%. According to modern data, the generation of children whose parents have had vesicoureteral reflux has a 70% risk of developing this disease. A higher occurrence of the disease was noted in the white race. A one-sided process is observed in 50-60%. Bilateral - in 40-50% of observations.

[6], [7], [8], [9]

Causes of the vesicoureteral reflux

Bladder ureteral reflux is a poly-ietic disease.

The main cause of the primary form of the disease is congenital malformation of the ureteral orifice:

• persistent yawning of the mouth ("funnel-shaped" configuration of the ureter's mouth); 
• the location of the mouth of the ureter outside the Lieto triangle (dystopia of the ureteric orifice);
• short submucosal tunnel of the intravesical ureter; 
• doubling of the ureter; 
• paraurectal diverticulum.

[10]

Symptoms of the vesicoureteral reflux

There are no characteristic symptoms of vesicoureteral reflux. Revealed urinary infection, pyelonephritis, arterial hypertension, renal failure in many cases are complications of vesicoureteral reflux. The clinical signs of these complications should alert the clinician: it is necessary to find out the cause of their occurrence.

The most common symptoms are pain that occurs during or immediately after the act of urination. In young children, the pain is usually localized in the abdomen, in older patients - in the lumbar region.

Diagnostics of the vesicoureteral reflux

The increase in the number of identified patients with this pathology has recently been associated with a rapid introduction of new diagnostic methods: antenatal ultrasound, a complex urodynamic study, radioisotope methods for assessing kidney function and endoscopy.

The stepwise approach allows to determine objectively, from unified pathogenetic positions, indications for operative and conservative treatment and to evaluate its results. Examination of the patient for vesicoureteral reflux (or suspected of it) should include the following steps.

[11], [12], [13], [14], [15], [16], [17]

Treatment of the vesicoureteral reflux

Modern treatment of vesicoureteral reflux includes a set of measures (therapeutic and operational) aimed at eliminating the cause of pathology and eliminating its consequences. The choice of the method of correction of the disease, of course, is determined by its cause and form.

If the cause of the development of pathology is the inflammatory process in the urinary spasm, then most often (this primarily affects the girls) in patients with minor violations of kidney function and vesicoureteral reflux I-II degree. In this case, with the help of cystoscopy, the patients reveal characteristic signs of chronic cystitis, the mouth is located in the usual place and has a slit or conical shape according to Lyons. It is necessary to evaluate the effectiveness of previously conservative treatment in patients: in the case of irregular use of drugs or the absence of complex pathogenetic treatment, conservative therapy is prescribed.