Vesicorenal Reflux

Vesicorenal Reflux

Vesicorenal reflux is a backflow of urine from the bladder into the ureters or even back into the renal pelvis. Backflow can occur when the valve function at the point where the ureter enters the bladder is disrupted. Bacteria can enter the renal pelvis through the reflux of urine and cause pelvic inflammatory disease. Chronic reflux of urine can lead to kidney dysfunction.

What is Vesicorenal Reflux?

The two ureters, which flow into the bladder from the two renal pelvis in the ureter opening, normally only allow urine to pass in the direction of the bladder.

The opening in the ureter acts as a valve, so to speak, to prevent urine from flowing back towards the kidneys. If the valve function is disturbed, the urine can flow back (reflux) into the upper ureters or even into the renal pelvis. The disorder can occur in one or both upper ureters. For contagious impetigo explanation, please visit percomputer.com.

The malfunction at the entry point of the ureter into the bladder is usually congenital, but can also be acquired later. Reflux is assigned to one of five classes from Class I to Class V depending on its severity. Reflux can lead to urinary tract infections and pyelitis and ultimately – if the disease is not treated – cause severe kidney damage or even a loss of function of the kidneys.

Causes

A primary vesicorenal reflux occurs when the reflux – as in most cases – is caused by a genetically determined maldevelopment. As a rule, the end course of the ureters in the bladder wall is too short, so that a pressure build-up in the bladder does not lead to a complete closure of the ureters, but part of the urine is pushed back again.

Another form of the genetically determined developmental disorder is when a ureter is doubled (ureter duplex), which can also cause urinary reflux. A secondary or acquired vesicorenal reflux is present if the reflux only occurs later due to external circumstances.

This can be caused by a urinary tract infection or direct damage, e.g. B. can arise in a ureteral endoscopy with expansion of the ureters. A nerve disease ( spina bifida ) and a congenital narrowing of the urethra can also be considered as causes of reflux.

Symptoms, Ailments & Signs

Vesicorenal reflux is only associated with symptoms in the late phase. Those affected then complain of pain when they urinate. Reflux can vary in intensity. All age groups are affected. Children often experience healing without medical intervention.

Patients regularly report that their urine takes on a foul odor. The urge to empty the bladder has also increased significantly. A burning sensation during urination and cramps appear. Vesicorenal reflux is often associated with susceptibility to infection. Pain along the entire flank. Stomach pain and diarrhea are also possible side effects.

Vesicorenal reflux makes kidney infection likely. As a result, inflammation of the renal pelvis sets in. Those affected then complain of an elevated temperature. Chills are also possible. Severe kidney pain occurs when going to the toilet. Failure to receive medical treatment can result in kidney failure.

Long-term consequences affect urination. Incontinence or uncontrollable urination is part of everyday life and represents a psychological burden. At night, children are known to wet their beds. Sometimes hypertension even develops. Growth disorders can even occur in minors.

Diagnosis & History

Since most cases of reflux are congenital malformations within the urinary tract and these are not visible from the outside, infants and young children can be underweight and pale, fever, rewetting, vomiting or diarrhea and abdominal pain as symptoms of the presence of a primary vesicorenal Reflux, especially if cases are known in the family.

In adolescents and adults, the urge to urinate with burning when urinating, unpleasantly foul-smelling urine, kidney pain and painful urination can indicate reflux. The symptoms should be clarified in more detail. The most important diagnostic methods are ultrasound, urine stream measurement and a voiding cystourethrogram, with which the ability of the ureters to close at the bladder inlet can be measured.

Depending on the severity of the reflux, if left untreated, dilated ureters and chronic inflammation of the renal pelvis can result in kidney failure. In less severe cases, spontaneous healing can also be observed in children up to the age of 10.

Complications

In many cases, this disease does not cause any special symptoms or complications, so that the disease is only discovered relatively late. Those affected primarily suffer from bedwetting. This can also have a very negative effect on the psyche of the person concerned and thus also lead to bullying or teasing of the patient.

Many of those affected continue to suffer from depression and significantly reduced self-esteem or inferiority complexes. The quality of life is significantly restricted and reduced by the disease. Renal insufficiency also occurs if the disease is not treated. In the worst case, those affected can die.

They are then dependent on a kidney transplant or on dialysis in order not to die. The disease can also lead to growth disorders, especially in children, so that complications can also arise in adulthood. When urinating, there is often pain and the urine smells very unpleasant.

The disease is usually treated by surgery. Complications do not arise. As a rule, all complaints can be restricted and alleviated in this way. Whether the disease has a negative impact on the patient’s life expectancy depends heavily on the time of diagnosis.

When should you go to the doctor?

Irregular urination, cramps in the abdomen or a burning sensation in the bladder, kidneys and ureters are signs of an existing disease. A doctor’s visit is necessary if the symptoms persist or increase for several days. Diarrhea, general malaise and inner irritability are other symptoms of a disorder. If there is a loss of appetite, abnormal behavior or an inner weakness, the person concerned needs a doctor. A general feeling of illness, weakness, incontinence or an increased body temperature should be medically examined and treated.

Sweating, chills or abnormalities in the cardiovascular system must be assessed. A doctor’s visit is necessary if the urine smells abnormal, looks pale, has abdominal pain or a hunched posture. Withdrawal behavior, nighttime wetting, vomiting, and nausea also need to be presented to a doctor.

If growth disorders appear in children, the observations should be discussed with a doctor. If there are psychological abnormalities, an aggressive appearance and apathy, the person concerned needs help. A persistently reduced quality of life can lead to serious complications. If the course of the disease is particularly unfavorable, the patient may die prematurely. Therefore, cooperation with a doctor should be sought at the first irregularities and abnormalities.

Treatment & Therapy

For moderate-severity reflux, treatment with low-dose antibiotics is recommended to prevent inflammation in the urinary tract. If reflux is more severe and there is a risk of renal dysfunction, surgical intervention is indicated.

The ureter is severed from the bladder and replanted in the bladder in an extended section. Several different surgical methods are available for this open surgical procedure, the antirefluxive ureter implantation. The chances of success for the intervention are high and are given as over 90%.

There is also the option of injecting medication under the ureter into the bladder wall during a cystoscopy. The drug is designed to narrow the ureter and stop the backflow of urine. This minimally invasive procedure avoids the risks of open surgery, but has the disadvantage of a lower success rate.

Prevention

A direct preventive measure to avoid primary reflux is not possible. However, if cases of reflux are known in the family, investigations are recommended to rule out possible reflux.

If reflux has already been diagnosed, it is recommended to empty the bladder in at least 2 stages and to wait several minutes after the first emptying, because then urine that has been pushed back can flow from the ureters back into the bladder and be excreted if the 2nd emptying is done with as little as possible printing is done.

Aftercare

Follow-up treatment is required when vesicorenal reflux is treated by surgery, which is done in childhood. In most cases the operation is successful. As part of the follow-up care, the child who has been operated on will still receive antibiotics as a preventive measure once they have left the hospital.

So the administration of antibiotics must be continued for a certain time. For about two to four weeks it is necessary for the child to rest physically. If, on the other hand, an endoscopic ostium injection takes place, there is no need for physical protection.

The check-ups are an important part of the aftercare. Three weeks after the procedure, an ultrasound examination (sonography) and an examination of the urine are carried out. Further checks take place after three months and after one year.

The success rate is particularly high for open procedures. Therefore, an additional routine reflux test in the form of a voiding cysturethrogram (MCUG) is not required in these cases. In the case of an endoscopic ostium injection, an MCUG is only performed in exceptional cases three months after the operation, which ultimately depends on the extent of the reflux and the healing process.

A particularly important aftercare measure is the control by sonography, which is carried out with the special 4D ultrasound technique and is used to detect recurrences. It takes place three to six months after the surgical procedure.

You can do that yourself

In most cases, vesicorenal reflux heals on its own. The most important self-help measure is infection prevention by maintaining a healthy lifestyle.

If the vesicorenal reflux persists, therapeutic treatment is necessary. After the operation, rest and rest apply. Patients should also drink plenty of water to promote the flushing out of any viruses. The doctor treating you can name the exact measures. In any case, vesicorenal reflux must be closely monitored by a doctor. It is important to have the condition clarified at an early stage. If symptoms such as pain or problems with urination occur, the doctor must be informed.

In addition to painkillers prescribed by a doctor, there are various natural painkillers, such as preparations with St. John’s wort or valerian. In addition, cooling and warming pads aid in recovery by relieving pain and increasing blood flow to the affected area. Since the urinary tract is very sensitive, the use of irritating home or natural remedies should first be discussed with the doctor treating you. With these measures, the vesicorenal reflux should heal reliably after the operation.

Vesicorenal Reflux