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Bladder-ureteral reflux in children


Pathology may be due to:

  • impaired renal function (pyelonephritis),
  • congenital abnormalities of the urinary tract,
  • neurological pathologies of the ureter.

The primary pathology diagnosed in newborns can be associated with congenital malformations: protrusion of the bladder, improper location of the mouth of the ureter, irregular shape of the mouth. Pathology can appear against the background of a loose closure of the sphincter of the bladder. In this case, the disease is also characterized by incontinence.

MTCT in older children and adults is a secondary disease that develops against the background of inflammatory diseases of the bladder and kidneys.

The secondary reflex in children may be due to overactive bladder or wrinkling.

The risk of developing the disease increases many times with abnormal development of the penis in boys, which can cause a malfunction of the urinary system. Timely treatment of this condition will help to avoid PMR in a child.

Degrees of pathology

Depending on the changes occurring in the bladder, there are 5 degrees of severity of the course of reflux:

  1. 1 degree - urine enters the middle section of the ureter,
  2. 2 degree - throwing urine into the pelvis of the kidney,
  3. Grade 3 - expansion of the pelvis-renal system of the kidneys,
  4. 4 degree - change in the diameter (rounding) of the cups and pelvis of the kidney,
  5. Grade 5 - exhaustion of the renal parenchyma, development of dysfunction.

In the first two cases, treatment is often not performed. Expectant tactics are selected, the patient is regularly examined for timely detection of pathological changes in internal organs or the progression of the disease.

Often in a child, a mild form of the disease passes with age, as it grows.

Primary reflux is caused by congenital pathologies and is diagnosed in newborns in the first days of life. A secondary form of pathology is characteristic of children older than a year who have undergone infectious diseases of the kidneys and bladder. MTCT at an early age manifests itself as a complication of cystitis, pyelonephritis or hydronephrosis. You can avoid the violation if the inflammation is treated in a timely manner.

An active, passive and mixed form of pathology is also distinguished. With active reflux, urine reflux occurs only during urination. With a passive form of the disease, this process does not depend on the frequency of going to the restroom. Mixed pathology includes both symptoms.

Symptoms of pathology

With bladder reflux in children, the symptoms of the disease directly depend on the severity of the pathology. A mild form may be asymptomatic.

Starting from the stage of changing the structure and size of internal organs, the following symptoms are noted:

  • fever
  • cloudy urine
  • swelling of the lower extremities,
  • swelling of the skin of the face,
  • general malaise - chills, headache, fatigue.

As you can see, the pathology is characterized by the symptoms of impaired renal function.

The difficulty in the diagnosis lies in the fact that parents of young children often take pathology for a common cold and do not consult a specialist.

It is important to understand that with reflux, taking antipyretic drugs can adversely affect the general well-being of the patient. The child should be shown to the doctor as soon as possible and undergo a comprehensive examination.

What is the disease dangerous?

Reverse urine reflux leads to the development of a number of secondary pathologies of an infectious nature. Urine is a favorable environment for the propagation of pathogenic microorganisms.

Against the background of bladder reflux in children, even with initial degrees of severity of the disorder, pain is observed during urination. Over time, a constant violation of urination leads to the development of an infection of the bladder and kidney disease. Secondary cystitis and pyelonephritis are often diagnosed.

In addition, PMR leads to the development of stagnant processes in the kidneys. In addition to pyelonephritis, against this background, there is a high risk of disruption of the organ and the development of renal failure.

With a change in the structure of the kidneys, drug treatment does not bring results, pathology requires surgical treatment.

Another characteristic complication of reflux is an increase in blood pressure in young children.

It is interesting that reflux can be a consequence of infectious and inflammatory diseases, and the cause of their development. Timely diagnosis plays a crucial role in preventing the development of a number of dangerous complications.

Diagnostic measures

Since the symptoms of the disease are often mistaken for acute respiratory viral infections, a comprehensive diagnosis is necessary, which includes:

  • blood and urine tests,
  • ultrasound examination of the kidneys and bladder,
  • cystourethrographic examination.

Further treatment is determined only by the results of a comprehensive examination.

Treatment principle

In case of a mild (first) degree violation, drug treatment is not prescribed.

Refusal of salt, normalization of the diet and systematic observation by a doctor are shown. The child should regularly take a blood test, undergo an examination of the kidneys and bladder.

Starting with the second degree of severity of the pathological process, drug therapy is used. First of all, it is necessary to minimize the risk of inflammation. The human bladder is practically sterile. Stagnant urine and its reflux violates the normal environment and increases the risk of bacterial infection. Antibacterial therapy is used to minimize the risks of infection.

Additionally, drugs can be prescribed to normalize blood pressure. Non-steroidal anti-inflammatory drugs are not used to relieve pain, as they increase the burden on the kidneys.

At the time of treatment, the patient is recommended a special diet, moderate physical activity and physiotherapy (massage).

Timely drug treatment can achieve success in 80% of cases. In severe pathology (grade 4-5), surgical intervention is indicated.

Two operational methods of treatment are practiced - this is laparotomy and valve placement. Laparotomy is indicated in cases where reflux is provoked by a violation of the ureter sphincter. This is a cavity operation, performed under anesthesia.

Often it is practiced to install a special implant (a kind of valve), which prevents the urine from being thrown back during urination.

At the last stages of the disease, surgery is necessary, otherwise the development of renal dysfunction is possible.

Only timely diagnosis and drug therapy will help to avoid surgical intervention. In most cases, this allows you to cure the disease once and for all, without any negative consequences.

Medical expert articles

Bladder-ureter reflux in children is a pathological condition characterized by the return of urine from the bladder to the upper parts of the urinary system due to a violation of the valve mechanism of the uretero-vesical segment.

Anatomy of the vesicoureteral segment: the uretero-vesical anastomosis (UVS) consists of the juxtasical part, the intramural part and the submucosal part ending in the mouth of the ureters. The length of the intramural section increases from 0.5 to 1.5 cm, depending on age.

The anatomical characteristic of the normal mechanism of the uretero-vesical anastomosis includes the oblique entry of the ureter into the Lietot triangle and the sufficient length of its intravesical division. The ratio of the length of the submucous tunnel to the diameter of the ureter (5: 1) is the most important factor determining the effectiveness of the valve mechanism. The valve is mainly passive, although there is an active component provided by the ureterotrigonal muscles and urethral membranes, which at the time of detrusor contraction close the mouth and submucous tunnel of the ureter. Active peristalsis of the latter also prevents reflux.

A feature of the vesicoureteral segment in young children is a short inner ureter, lack of Waldeyer fascia and a third layer of muscle in the lower third of the ureter, a different angle of inclination of the intravesical part of the ureter to its intraparietal part (right angle in newborns and oblique in older children), muscle weakness elements of the pelvic floor, intraparietal ureter, fibro-muscular vagina, urinary vesicle triangle Lieto.

In newborns, the Lietot triangle is located vertically, as if it were a continuation of the posterior ureteric wall. In the first year, it is small, poorly expressed and consists of very thin smooth muscle bundles tightly adjacent to each other, separated by fibrous tissue.

The emergence and progression of vesicoureteral reflux at an early age is facilitated by the underdevelopment of the neuromuscular apparatus and the elastic skeleton of the ureter wall, low contractility, impaired interaction between ureteral motility and bladder contractions.

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How is the disease?

Kidney reflux is a pathological condition in which there is a reverse movement of urine into the kidneys from the bladder.

Pathology has two development options:

  1. Renal ureteral reflux in children - in this case, urine reaches the ureters, and then returns to the kidneys.
  2. Pelvis-renal reflux - the contents of the pelvis reaches other parts of the kidney.

The structure of the bladder has such features that when you urinate, the urethra muscles relax and the sphincter opens, blocking the duct. If the sphincter closes partially or not completely, urinary incontinence occurs.

The closure of the mouth during urination is normal, in which case the urine cannot return. If reverse kidney reflux occurs against the background of abnormal changes, then the pelvis is dilated and urine returns to the kidney. Due to such violations, damage and changes in the structure of the kidney tissue develop, which entails a violation of the functions of the kidney.

In addition, kidney reflux in children can be classified into the following types:

  1. Primary - occurs against the background of congenital malformations of the urinary system, observed in early childhood. These include doubling of the ureter, dystopia of the ureteral mouth, defects in the bladder wall, violation of the structure of the ureters, pathology of the urethral sphincters.
  2. Secondary - It can occur after operations on the bladder and kidneys, chronic inflammation, phimosis, strictures of the urethra or ureters, with an overactive bladder and other acquired diseases. More characteristic for children over 5 years old and adult patients.

Reverse reflux in the kidneys more often occurs on the one hand (right-side or left-side), but in some cases, a bilateral process may occur. In the vast majority of cases, the disease is observed in children under the age of 2 years.

This pathology has various degrees of severity, which affect both the symptoms and further treatment.

There are such degrees:

  • 1 degree - reflux in the ureter, the pelvis is not affected.
  • 2 degree - the pathological process reaches the pelvis.
  • 3 degree - there is an expansion of the ureter.
  • 4 degree - against the background of reflux, the ureter wriggles, kidney function decreases by 30-50%.
  • 5 degree - kidney function is disturbed by more than 60%, the parenchyma is thinned, a chronic inflammatory process develops.

When kidney reflux is observed in children, symptoms do not always occur, and young children cannot accurately indicate the nature of the ailment. Quite often, the first clinical manifestations of reflux are acute pyelonephritis and cystitis. In addition, there is an increase in body temperature, pain in the lumbar region after urination, a feeling of fullness in the region of the kidneys, swelling and thirst.

With prolonged reflux in older children without proper treatment, intoxication develops, increased pressure is noted.

Note! Reflux can be passive, in this case, the penetration of urine into the kidney is not associated with the process of emptying the bladder.

Methods for diagnosing childhood reflux

In order to link the symptoms and treatment together, the specialist needs another link - diagnosis. With the help of various studies, the doctor will be able to confirm the diagnosis and identify its cause.

To begin with, a physical examination is performed: blood pressure is measured, temperature, kidneys are palpated. Also prescribe KLA, in which the results will be an increased level of white blood cells and increased ESR.

In addition, the instruction implies the appointment of the following studies:

  1. Ultrasound procedure - It is possible to suspect the presence of pathology by the expansion of the renal pelvis.
  2. Cystogram - the bladder through the catheter is filled with a contrast agent and a series of shots are taken, according to which it is possible to establish the reflux of urine into the ureter and kidneys.
  3. Cysturethrogram - It has the same principle of conduct as the cystogram with PMR of the kidney, but the pictures are taken using x-rays. Images are obtained in more detail, but the dose is greater.

Treatment should eliminate the cause of reflux, if possible. With congenital anomalies, long-term therapy is prescribed, and after that, surgery.

The main goals of treatment:

  • restore normal urodynamics and passage of urine,
  • reduce uncomfortable symptoms
  • prevent complications
  • remove the inflammatory process.

As part of conservative therapy, a diet with a reduced amount of salt and an individual selection of the daily amount of fluid are prescribed. In addition, baths with sea salt and installations with silver are used for the development of cystitis against a background of reflux.

In the course of drug treatment, antibiotics are most often used, which reduce the risk of inflammation in the kidneys or eliminate it. For children, preventive doses are selected from drugs of the penicillins or cephalosporins group. In addition, the use of uroantiseptics and fluoroquinolones is possible.

Surgical treatment is not prescribed immediately, but only with certain indications, for example:

  • in the absence of the effect of conservative therapy,
  • the last stages of the disease
  • rapid progression of renal failure,
  • persistent inflammatory process,
  • decreased renal function by more than 30%,
  • recurrent pyelonephritis and / or cystitis.

The price of treatment is now very affordable, at the moment, surgical intervention is preferable to provide endoscopic methods. The advantage of this method: it can be performed even in infants, the duration of the intervention with anesthesia does not exceed 30 minutes.

From the photos and videos in this article, we received information about what is associated with the development of renal reflux in childhood, examined the classification of this pathology, and learned how to diagnose reflux.

Real complications

Hello. My daughter is 2.5 years old, recently we have been diagnosed with kidney reflux. Tell me, can any complications develop?

Good evening. Without adequate treatment, reflux leads to a change in kidney function; scars form on the affected tissues. There is also a real connection between reflux and the further development of hypertension and the appearance of kidney stones.