Vesicoureteral reflux (Pediatrics)
Summary/Definition
Vesicoureteral reflux is a disease in which urine from the bladder returns back to the kidneys through the ureters. Vesicoureteral reflux is observed in about 1% of healthy children and in about a third of children suffering from infections of the genitourinary system. This condition can lead to infections of the genitourinary system and, in severe cases, to impaired kidney function. Vesicoureteral reflux can be treated surgically. According to the classification of reflux severity by the International Research Council, the severity of reflux can be assessed on a scale of 1 to 5 points. A higher degree of reflux is associated with an increased risk of kidney damage.
Urine reflux from the bladder to the ureters is divided into primary and secondary. Primary reflux is usually associated with congenital malformations or may occur as a result of acquired diseases. Congenital malformations include disorders of bladder filling, abnormalities in the structure of the upper urinary tract, lower urinary tract, as well as narrowing or diseases of the bladder. Among the acquired diseases, neurogenic disorders of the bladder, the need for surgical interventions to correct the connection between the bladder and the ureter, and inflammatory reactions can be distinguished.
Symptoms
Vesicoureteral reflux is more common in girls, and is usually diagnosed at the age of 2-3 years. Symptoms of vesicoureteral reflux are similar to signs of urinary tract infection and include pain when urinating, frequent urination, vaginal discharge, side pain, headaches and high blood pressure. Vesicoureteral reflux can be treated surgically.
Diagnostics
Diagnosis of vesicoureteral reflux is carried out using the following methods: urethral cystourethrography, which is performed by inserting a catheter into the bladder through the urethra of a child to diagnose the presence of reflux; ultrasound, which analyzes the structure of the bladder and ureters and helps to identify signs of vesicoureteral reflux; a test based on nuclear medicine that tracks the movement of urine injected into the bladder and ureters using radioisotopes, and is the most accurate method for diagnosing the presence of reflux in the bladder. Varieties of tests based on nuclear medicine include isotopic urethrography of the bladder during urination and DMSA nephrectomy.
Treatment and course of the disease
Without a urinary tract infection, reflux by itself usually does not cause kidney damage. However, severe reflux accompanied by urinary tract infection can lead to the development of pyelonephritis and scarring in the kidneys. The main goal of treatment is to prevent complications caused by vesicoureteral reflux, such as pyelonephritis, kidney damage, kidney scarring and high blood pressure, as well as to maintain normal kidney growth and their main function. If urinary tract infections continue to occur despite medication, or if the kidneys gradually undergo scarring, surgical intervention may be required. Treatment includes the use of antibiotics or anticholinergic drugs as part of drug therapy, as well as non-drug methods such as endoscopic mesotherapy. If necessary, surgical treatment is performed, including repeated ureteral transplantation. Risk factors for the development of vesicoureteral reflux include congenital malformations and hereditary burden. For prevention, hygiene measures can be observed, for example, maintaining the cleanliness of the genitals and preventing the use of foreign objects to wipe inside the foreskin that covers the head, if it is preserved.
Complications
Complications associated with vesicoureteral reflux include the development of urinary tract infections, scarring and kidney atrophy, as well as chronic kidney disease. Urinary tract infections are caused by the multiplication of bacteria in the residual urine in the bladder, whereas scarring and kidney atrophy are manifested in the case of recurrent urinary tract infections when infected urine penetrates the kidney parenchyma. It should be noted that chronic renal failure has a high clinical significance and accounts for 15-20% of cases of end-stage renal failure in children and adolescents.
