What is vesicoureteral reflux and what are its symptoms?

Vesicoureteral reflux is an uncommon urinary disease in life. It is more common in children and has serious impacts on patients. Let’s take a look at what kind of disease it is!

What is vesicoureteral reflux

Vesicoureteral reflux refers to the loss of the anti-reflux function of the ureteral bladder wall due to congenital or acquired reasons. When urine flow accumulates or the detrusor contracts and the pressure in the bladder increases, urine flows back from the bladder into the ureter or even the renal pelvis. These reasons include congenital incomplete valve function at the vesicoureteral junction or secondary to urinary tract obstruction and neurogenic bladder dysfunction.

It often presents with non-specific symptoms of urinary tract infection and reflux, including fever, fatigue, lethargy, anorexia, nausea, vomiting, and growth retardation. There may also be renal colic and tenderness in the kidney area. If secondary infection occurs, symptoms of frequent urination, urgency, and pain during urination will appear. In severe infections, purulent urine may occur. Occasionally, soreness and pain may also occur after fatigue. Those with combined renal scarring may seek medical treatment due to hypertension. The most serious consequence is the occurrence of pyelonephritis scars, leading to secondary hypertension and chronic renal failure. In addition to the enlarged kidneys, thickened ureters may occasionally be touched during physical examination. There may be mild percussion pain in the kidney area. Bilateral vesicoureteral reflux may cause symptoms of renal insufficiency.

Diagnosis is not difficult based on clinical manifestations, imaging and endoscopic examinations.

The treatment of vesicoureteral reflux should be based on different examination results, different causes and levels. Before treatment, the following situations should be noted:

1. There is a hope that reflux will disappear on its own, which is related to the patient's age and the degree of reflux. Duckett (1983) reported that if the infection can be controlled, 63% of grade II, 53% of grade III, and 33% of grade IV reflux can disappear on their own. With age, many grade I to III reflux can heal on their own, but grade V is difficult to heal on its own.

2. Long-term anti-infection treatment is safe and tolerable for children.

3. Complications such as bladder diverticulum and uninhibited bladder cannot prevent the reflux from disappearing on its own.

4. If the ureteral diameter and bladder are normal, the success rate of ureteral bladder reimplantation can reach 95% to 98%.

5. If reflux persists into adolescence or adulthood, it is not easy to disappear on its own. Reflux in adult men is not necessarily pathological, but it can cause problems for women, especially during pregnancy.

6. Reflux without infection does not appear to cause kidney damage.

7. Non-surgical treatment Mild reflux (grade I, II, and III) is suitable for non-surgical treatment, the purpose of which is to control urinary tract infection with drugs and prevent pyelonephritis from damaging the kidneys. Use appropriate antibiotics and cooperate with scheduled urination and continuous urination to reduce residual urine in the bladder. Regularly review urine routine, urine culture, and urination period cystourethrography to observe the efficacy.

8. Surgery is required for patients with severe reflux (IV, V degrees), progressive reflux or persistent reflux into adulthood, and patients with recurrent exacerbations of pyelonephritis that cannot be controlled by medication. The purpose of surgery is mainly to extend the length of the ureter under the bladder mucosa. It is best to make the length of the submucosal tunnel 5 times the diameter of the ureter. For obviously dilated ureters, ureters need to be cut and then reimplanted into the bladder.

9. Endourology surgery uses a cystoscope to inject a sclerosant under the mucosa of the ureteral orifice to change the shape of the ureteral orifice and tighten it to achieve the purpose of anti-reflux. Commonly used sclerosants include: polytetrafluoroethylene (Teflon), collagen, etc.