What Is Ureteral Reflux?

Bladder ureteral reflux (VUR) refers to the backflow of urine from the bladder to the ureter and renal pelvis during urination. Reflux nephropathy (RN) is a syndrome due to VUR and intrarenal reflux (IRR) accompanied by repeated urinary tract infections that cause scarring, atrophy, and abnormal renal function in the kidney. If left untreated, it can progress to chronic renal failure . VUR not only occurs in children, but also continues to adulthood on the basis of repeated UTI (urinary tract infection), leading to impaired renal function. Numerous data indicate that RN is one of the important causes of end-stage renal failure.

Basic Information

English name

vesicoureteral reflux

Visiting department

Urology

Common causes

Congenital bladder submucosal ureter is too short or horizontal, ureteral opening is abnormal, etc.

Common symptoms

Frequent urination, urgency, pain and fever, high blood pressure, etc.

Causes of bladder ureteral reflux

The main mechanism that causes VUR is the abnormality of the bladder ureter connection, which can be divided into the following two categories according to the cause:

Primary reflux

The most common are congenital bladder and ureteral valve insufficiency, including congenital bladder short or horizontal ureter, abnormal ureter opening, thinning of bladder deltoid muscle, weakness, congenital abnormality of Waldeyer sheath, etc. Half of the patients have reflux due to abnormal bladder detrusor function.

Secondary reflux

Factors that cause Waldeyer's sheath dysfunction include UTI, bladder neck and lower urinary tract obstruction, trauma, pregnancy, etc. Pediatric UTI concurrent reflux is as high as 30% to 50%. During the UTI, the bladder and ureteral section lost normal valve function due to inflammation, swelling, and deformation. UTI's main pathogenic bacteria are easy to bind to urethral epithelial cells, which weakens the peristaltic function of the ureter and causes reflux, which can gradually disappear after controlling infection. About 40% to 70% of patients with urinary tract malformations and reflux. In addition, bladder ureteral insufficiency, such as primary neurospinal insufficiency, including meningocele, etc., VUR occurred in about 19% of cases.

Clinical manifestations of bladder ureteral reflux

There may be no symptoms due to mild reflux, and the following symptoms may occur when the reflux is severe or infected.

Urinary tract infection

Frequent urination, urgency, dysuria, and fever are typical acute pyelonephritis in severe cases.

2. Hypertension

It is a common complication at the later stage and the most common cause of malignant hypertension in children.

3. Proteinuria

Tips have developed to renal reflux.

4. Developmental disorders

This disease is often accompanied by developmental disorders. If you have a history of chronic urine sensation with developmental disorders, you should think of this disease.

5. Renal insufficiency

Renal insufficiency develops due to renal scarring due to intrarenal reflux. 15% to 30% of patients with chronic urinary tract infection with bladder ureteral reflux can develop renal insufficiency.

Bladder ureteral reflux examination

Laboratory inspection

UTI routine urine examination showed positive urine and bacterial culture. Urine tests at RN reveal protein, red blood cells, white blood cells, and various casts. Renal function tests are normal or abnormal.

2. Ultrasound

B-ultrasound can be used to estimate the function of the bladder and ureteral junction, observe ureteral dilatation, peristalsis and continuity of the base of the bladder, observe the shape of the pelvis, kidney, and parenchyma. Someone inserts a ureteral catheter at time B and injects gas (such as CO ₂ ). If the gas enters the ureter, VUR can be diagnosed. Color Doppler ultrasound was used to observe the function of the junction and the position of the ureteral opening. However, B-ultrasound has limitations on the detection of upper pole scars, and VUR cannot be classified.

3.X-ray inspection

(1) Urinary bladder urography (MCU) This is the commonly used basic method for the diagnosis of VUR and the "gold standard" for grading. Five-level classification proposed by the International Reflux Committee:

Grade I: Urinary reflux is limited to the ureter.

Grade : Urinary reflux to the ureter and renal pelvis, but no dilatation, and renal calyx is normal.

Grade III: mild, moderate dilatation and / or distortion of the ureter, moderate dilation of the renal pelvis, and no (or) mild dullness of the fornix.

Grade : Moderate dilatation and distortion of the ureter, moderate dilation of the renal pelvis and calyces, complete disappearance of the dome angle, and most of the calyces maintain nipple pressure.

Grade : severe dilatation and distortion of the ureter, severe dilation of the renal pelvis and calyces, and most of the calyces do not show nipple pressure.

(2) Intravenous pyelography (IVP) can further confirm the diagnosis of renal atrophy and renal scar formation. In recent years, it is believed that high-dose intravenous pyelography and X-ray tomography can better show scars.

4. Radionuclide inspection

(1) Direct measurement and indirect measurement of radionuclide bladder imaging points, used to determine VUR.

(2) Dimercaptobutylene scintillation (DMSA) scanning technology is the only "gold standard" for diagnosing RN in children, especially children over 5 years old. Coldraich classifies kidney scars into four grades based on DMSA scanning photography signs:

Grade I: One or two scars.

Grade : Two or more scars, but the renal parenchyma is normal between the scars.

Grade III: Diffuse damage throughout the kidney, similar to obstructive nephropathy, with atrophy of the whole kidney, with or without scarring of the kidney contour.

Grade IV: End-stage, atrophic kidney, little or no DMSA uptake (less than 10% of total renal function).

Diagnosis of bladder ureteral reflux

Because the clinical diagnosis of VUR is often inconspicuous or has non-specific manifestations, the diagnosis depends on imaging studies. The possibility of reflux should be considered in the following situations:

(1) Repeated recurrence and prolonged UTI.

(2) Long-term frequent urination, dripping urine or enuresis.

(3) Younger than 2 years.

(4) Continuous positive urine culture.

(5) UTI with urinary tract malformations.

(6) The first-degree relatives of the family have VUR and RN patients.

(7) Hydronephrosis in the fetus or infant.

Bladder Ureteral Reflux Therapy

It is mainly to stop the reflux of urine and control the infection to prevent further damage to kidney function.

Medical treatment

Treatment measures are adopted according to different classifications of VUR.

(1) and degree treatment of infection and long-term medication prevention. Available SMZCo (Compound Sulfamethoxazole Dispersible Tablets), taken at bedtime, even for more than one year. It is effective to prevent infection. Urine culture should be done every 3 months, radionuclide examination or urinary cystography should be done every year to observe the degree of reflux, and venography should be used every two years to observe the formation of renal scar. After the reflux has disappeared, urine culture must be done every 3 to 6 months, because reflux can sometimes be intermittent. In addition, drinking water and urinating twice before going to bed should be encouraged to reduce bladder pressure and maintain regular and regular bowel movements.

(2) degree treatment is the same as and degree, but the reflux should be checked every 6 months, and intravenous pyelography should be done every year.

(3) and degrees should be surgically corrected after preventive medication.

2. Surgical treatment

VUR surgical treatment is mostly plastic surgery. The indications for surgery are:

(1) Reflux above .

(2) Medical observation and treatment should be performed first before the third degree. Surgical reflux and new scar formation should be operated.

(3) Patients with recurrent urinary tract infection who did not improve reflux after 6 months of active treatment.

(4) Those with urinary tract obstruction.

At present, injection therapy is popular in foreign countries. This method is only for a short period of anesthesia, which requires short-term hospitalization or no hospitalization, and is easily accepted by patients.