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Symptoms of vesicoureteral reflux

Alexey Portnov, medical expert
Last reviewed: 19.10.2021

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Symptoms of vesicoureteral reflux are nonspecific. Revealed 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 the act of urination. In young children, the pain is usually localized in the abdomen, in older patients - pain in the lumbar region. One of the main symptoms of vesicoureteral reflux is the unexplained hyperthermia without catarrhal symptoms of the upper respiratory tract. Often, the symptoms of concomitant urological diseases come to the fore: cystitis (frequent painful urination), pyelonephritis (constant dull pain in the lumbar region), exacerbations of enuresis, etc. With the correct evaluation of the entire symptom complex, the doctor may suspect a vesicoureteral reflux and begin the necessary urological examination of the patient.

Types of vesicoureteral reflux

Now it is proved that vesicoureteral reflux is a pathological state with polymorphic etiology. According to the common etiological classification, there is a separation of vesicoureteral reflux into primary and secondary. Primary (congenital) vesicoureteral reflux is associated with dysplasia of vesicoureteral anastomosis, shortening of the intramural ureter, dystopia of the mouth, or a combination of the above. In the etiology of secondary vesicoureteral reflux may lie both congenital and acquired conditions: inflammatory diseases of the bladder, neurogenic dysfunction of the bladder and IVO, iatrogenic damage of the vesicoureterial anastomosis, contraction of the bladder, pregnancy.

Based on the data of cystography, passive and active reflux are distinguished. Passive vesicoureteral reflux occurs when the bladder is filled with a contrast solution and at rest after filling it. It should be remembered about the age norms of the capacity of the bladder, since the overflow of the latter leads to the creation of unnatural conditions and violation of the blocking mechanism of the vesicoureteral valve with the appearance of reflux (false positive result). Active vesicoureteral reflux occurs during urination and is associated with increased hydrostatic pressure within the bladder. Under normal conditions, the mouth of the ureter ("vesicoureteral valve") is able to restrain pressure from the bladder to 60-80 mm Hg.

The most common was the International Cystographic Classification in 1985. The authors recommended the allocation of five degrees of vesicoureteral reflux:

I - contrasts the pelvic ureter.
II - vesicoureteral reflux is noted throughout the ureter and the collecting system of the kidney.
III - the contrast material reaches the cup-and-pelvis system with the expansion of the latter.
IV - dilatation of the ureter and calyceal system is recorded.
V - massive vesicoureteral reflux with a pronounced dilatation of the ureter and the cup-and-pelvis system (knee-like ureteral bends, kidney parenchyma sharply thinned).

Taking into account the clinical course of the disease, transient and permanent forms of vesicoureteral reflux are isolated. For the transitional form, low cystographic degrees and a moderate degree of renal dysfunction are more characteristic. As a rule, transient reflux is detected when exacerbating intercurrent diseases (cystitis, pyelonephritis, vulvitis).

In recent years, there has been justified the 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.

I degree (moderate) corresponds to a decrease in kidney function to 30%.
II degree (average) - reduced function up to 60%.
III degree (high) - more than 60%.

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