Vesicoureteral reflux - Causes, Symptoms and Treatment .MF .
Vesicoureteral reflux - a disease that is characterized by reflux reflux of urine from the bladder into the ureter.
reasons vesicoureteral reflux
To date not yet find out the exact reason for the return throw urine from the bladder.Naturally, the immediate factor is the failure of the ureteral sphincter, but it is much more important to know the primary cause, since it is its treatment can prevent the development of disease.
Many papers are devoted to the study of the value of chronic inflammation in the pathogenesis of vesicoureteral reflux.Despite the fact that the consensus of urologists in this regard is still missing, many experts still lean toward the idea that it is a chronic salpingitis or pyelonephritis is the cause of the pathology.
can not be excluded and the innate factor in the development of the disease in children.In particular, it was shown that a variety of abnormalities in muscle and nerve sheath of the apparatus of the ureter are the most important etiological factors in the deve
Most often the disease occurs in those patients in whom there are two above the causal factor.When layering of infection on the anomaly of the ureter, the risk of vesicoureteral reflux increases several times.
can not exclude such a causative factor as urolithiasis.This is especially true when it comes to the presence of stones large or medium size, which can damage the muscular layer of the ureter, resulting in a violation of neuromuscular transmission and the formation of vesicoureteral reflux.
symptoms of vesicoureteral reflux
specific clinical picture for vesicoureteral reflux does not exist.Typically, patients treated for only one skilled in the presence of complications.For example, the most common complication of vesicoureteral reflux is acute pyelonephritis, which is manifested by pain in the lumbar region and signs of intoxication such as general weakness, malaise, headaches and insomnia whites.
At the same time, the disease is often accompanied by an increase in blood pressure.Patients complain of constant headaches, especially in the occipital region.This symptom may also be accompanied by a flashing "flies" in front of the eyes and dizziness, which, in some cases, even loss of consciousness ends.
degrees of vesicoureteral reflux
the presence of these symptoms in the patient, he should immediately seek help from a urologist.The designated specialist diagnostic tests to help make the correct diagnosis and to select the optimal treatment strategy.
Diagnosis of vesicoureteral reflux
Urinalysis, as a rule, does not deviate from the norm.An exception can be called those cases where, because of vesicoureteral reflux develops inflammation.In this situation, in the urine of the patient can be found an increased amount of leukocytes, erythrocytes and renal epithelium.
The only effective method to verify the diagnosis of vesicoureteral reflux is considered voiding cystography.It is the introduction of contrast medium through a urethral catheter into the cavity of the bladder and carrying out X-ray examination the pelvic area.In this pathology in the picture you can see the contrast of the casting cavity of the bladder into the ureters.
Voiding cystography: vesicoureteral reflux
Ultrasonography and other diagnostic methods of diseases of the genitourinary system, typically at reflux are not effective.Voiding cystography, due to its low cost and ease of implementation is carried out in almost any surgical or urological hospital.
In addition, you must also note the cystoscopy, which may also be effective in the diagnosis of vesicoureteral reflux.On examination of the bladder mucosa using a special optical device can be revealed during the retrograde urine into the ureter.At the same time significantly as the last valve is not fully closed when the peristaltic contractions of the bladder.
treatment of vesicoureteral reflux
As a rule, patients at the initial stage of the disease is assigned to watchful waiting, which is to periodic inspections by the urologist and the regular holding of cystoscopy in order to identify the progress of the disease.In the absence of the normal progression and the clinical condition of the patient can refuse to perform surgery.In cases where there is a severe clinical picture of the disease or complications observed, the operation is a must.
The aim of surgery is to eliminate vesicoureteral reflux by creating a new valve ureter.To date, proposed many methods of such an operation, but select only effective possible.The most commonly used surgical intervention with formation of a new valve by forming dublication mucosa.To this end, the outside of the ureter normal caproic stitched thread in such a way that, after tying a knot formed in the body lumen extending protrusion.Strictly speaking, this fold and is a valve that will prevent the backflow of urine from the bladder into the ureter.
most modern method of correction of this pathology is Inserting an artificial ureter valve, but in our country it is performed rarely because of the high cost and the need of a large arsenal of modern equipment.
rehabilitation after illness
Rehabilitation should be focused primarily on the prevention of disease recurrence.To do this, put a urethral catheter, to allow the urine evacuated in time into the cavity of the bladder, and not taken up intravesical pressure.
addition, crucial point is the prevention of infection, as the disease in most cases, is associated with inflammation.Patients are assigned antibiotics broad-spectrum cephalosporins and from the group of aminoglycosides.Ceftazidime and ampicillin enough to not only prevent secondary infection, but also to cure pyelonephritis, which may be the probable cause of vesicoureteral reflux.
addition, the urological practice often used physiotherapy treatments such as magnetic and darsonval.The purpose of their application is not only speedy healing of postoperative wounds, but also the improvement of neuromuscular transmission at the synapses, which play a very important role in the contractile activity of the ureter and prevents the development of disease recurrence.
Feeding habits and lifestyle
specific recommendations regarding diet there.Patients can eat almost any food.
As for the lifestyle, then it is somewhat complicated by the wearing of a urethral catheter for approximately one month after surgery.Patients should be taught how to change the catheter and is regularly incorporated into the cavity of the bladder antiseptic solutions.As the latter can use furatsillin and chlorhexidine.Once in the bladder cavity, they decrease in microorganisms ureteropuzyrnogo anastomosis area, thereby preventing inconsistency of the latter.
Treatment folk remedies
As already mentioned, for the treatment of patients treated, most likely, already at the stage of complications when it is necessary to use radical methods.If the time spent on useless treatment of folk remedies, the disease may result in chronic renal failure, which is often fatal.
Complications vesicoureteral reflux
The most common complication of vesicoureteral reflux should be considered as acute pyelonephritis, which occurs due to constant stagnation of urine in the renal pelvis cavity.As already mentioned, the patients' complaints of deterioration of the general status and local pain in the lumbar region.In this situation, you need to conduct an adequate antibiotic treatment in order to process is not ended renal abscess.
more serious complication of vesicoureteral reflux is a chronic renal failure that can occur in severe forms of vesicoureteral reflux.
For the same reasons, there is a development and kidney disease, which is also accompanied by pain in the lumbar region, but they, unlike pyelonephritis are not permanent and periodic nature, intensifying during physical exertion or injury to the lumbar.
The cause of hypertension is renal dysfunction.Due to the permanent stagnation of urine, a large amount of compensatory renin, which is a powerful vasopressor agent and reducing arterial vessels, leading to increased blood pressure.It should be noted that such hypertension is very resistant to medication, so if its correction is necessary, first of all, to eliminate vesicoureteral reflux, after which it is engaged in a decrease in blood pressure.
Prevention vesicoureteral reflux
First of all, for the prevention of vesicoureteral reflux any inflammation of the urinary tract must be removed.
The second step in the prevention of this disease can be considered as prevention and treatment of kidney stones, which can also act as an etiological factor of vesicoureteral reflux.All patients with this problem is assigned to a dietary food with the use of a minimum amount of salt.In the presence of large stones can not be excluded surgery, which can be conducted both laparoscopic and open way.
forecast vesicoureteral reflux
With timely diagnosis, proper and adequate treatment, the prognosis for life, healing and health is beneficial.
Ed.urologist, sexologist-andrologist Plotnikov AN