How is vesicoureteral reflux treated?

When choosing a treatment plan for vesicoureteral reflux and its complications, a finely differentiated approach is necessary, because surgical intervention on a relatively immature vesicoureteral segment can interrupt the natural maturation process and affect the function of the urinary system in the future. In addition, differential diagnostics of the causes of reflux (developmental defect, morpho-functional immaturity or inflammation) is difficult, which is especially typical for children under three years of age.

But it is necessary to remember that vesicoureteral reflux should be treated from the moment the pathology is detected. Indications for surgical treatment of vesicoureteral reflux are considered to be vesicoureteral reflux of the 3rd degree with the ineffectiveness of conservative therapy for 6-12 months; vesicoureteral reflux of the 4-5th degree.

The main principles of therapeutic treatment of vesicoureteral reflux are prevention of infectious diseases of the urinary system, correction of concomitant pathology of the urinary system, physiotherapy, prevention of renal tissue sclerosis, membrane stabilizing therapy.

In conservative treatment of vesicoureteral reflux, it is necessary to take into account the background against which this condition occurs. Thus, in the development of pyelonephritis, a longer additional course of uroseptics is necessary.

In the development of vesicoureteral reflux against the background of a neurogenic bladder, it is advisable to carry out measures aimed at correcting the neurogenic bladder.

In case of neurogenic dysfunction of the bladder of the hyporeflexive type, it is recommended:

• forced urination regime (every 2-3 hours);
• baths with sea salt;
• a course of adaptogens (ginseng, eleutherococcus, magnolia vine, zamaniha, rosea rhodiola, golden root, 2 drops of tincture per year of life in the first half of the day);
• glycine orally 10 mg/kg per day for a month;
• Physiotherapy: electrophoresis with proserin, calcium chloride; ultrasound on the bladder area; stimulation of the bladder.

In case of neurogenic dysfunction of the bladder of the hyperreflexive type, it is advisable to carry out the following measures:

• preparations of valerian, peony root, motherwort;
• belladonna preparations (belloid, bellataminal);
• pantogam orally 0.025 mg 4 times a day for 2-3 months;
• picamilon 5 mg/kg per day for 1 month.
• Physiotherapy: electrophoresis of atropine and papaverine on the bladder area; magnetic therapy (UHF-DKV); ultrasound on the bladder area; electrical stimulation of the bladder using a relaxing technique.

In case of vesicoureteral reflux, to improve the contractile activity of the ureters, it is recommended to prescribe dynamic currents to the ureter area in the amount of 10 procedures. A syncope rhythm is prescribed for 7-10 minutes. The course of physiotherapy is repeated after 1.5 - 2 months. 3-4 times.

To prevent renal tissue sclerosis, it is recommended to take riboxin and stugeron. Of the membrane-stabilizing drugs, vitamin B6 _and vitamin E are used.

The development of reflux nephropathy at any degree of VUR is an indication for surgical correction of reflux.

Before performing surgery, it is necessary to undergo a course of antibacterial therapy to prevent the manifestation or exacerbation of the pyelonephritic process.

In the development of reflux nephropathy in the pre- or postoperative period, it is necessary to take into account that this condition occurs against the background of cellular energy disorders of varying degrees. Therefore, all children are recommended to use succinic acid preparations (yantovit, mitamine) at 25 mg / day, and if there is data on the violation of the activity of mitochondrial enzymes - the use of an extended treatment regimen using drugs whose action is aimed at correcting the state of the mitochondria. In the development of nephrosclerosis, it is advisable to use anti-sclerotic drugs (vitamin B ₁₅, solcoseryl, stugeron, cytochrome C).

The main drugs used in complex treatment in the presence of signs of mitochondrial insufficiency

Name of the drug	Introduction	Dosages	Course of treatment
Yantovite	Per os.	25-50 mg/day	1-1.5 months. Three days every three days
Mini yantovite	Per os	See #1	Same.
Mitamin	Per os	See #1	Same
Elkar	Per os	50-100 mg/kg.	Zmes.
Coenzyme q10	Per os	30-300 mg/day.	Zmes.
Riboflavin	Per os	20-150 mg/day.	1 month
Thiamine	Per os	50 mg/day.	1 month
Pyridoxine	Per os	2 mg/kg/day.	1 month
Lipoic acid	Per os	50-100 mg/day.	1 month
Vitamin E	Per os	100-200 mg/day.	1 month
Dimephosphone	Per os	15-20 mg/kg	1 month
Vitamin B	Per os	100 mg/day.	1 month
Cytochrome C	B/m; B/v	20 mg/day.	10 days
Solcoseryl	B/m	2 ml/day.	2-3 weeks

Conservative treatment must be carried out under constant monitoring of the child's condition using laboratory and instrumental studies (general and biochemical analysis of urine and blood, activity of urine enzymes, blood urea and creatinine levels, ultrasound and Doppler examination of the kidneys, cystography, cystoscopy, intravenous urography and radioisotope examination of the kidneys).

Outpatient observation

Children with vesicoureteral reflux and reflux nephropathy should be followed by a nephrologist before transfer to the adult network.

Outpatient observation includes:

• examination by a nephrologist at least once every 6 months;
• urine analysis monitoring once a month and in case of intercurrent diseases;
• general blood test once every 3 months and in case of intercurrent diseases;
• biochemical blood test with mandatory determination of urea and creatinine levels once every 6 months;
• biochemical analysis of urine once every 6 months;
• analysis of mitochondrial enzyme activity once a year;
• urine enzyme activity analysis once a year;
• cystography after a course of therapeutic treatment, then once every 1-3 years;
• cystoscopy according to indications;
• Ultrasound and Dopplerography of the kidneys once every 6 months;
• radioisotope examination of the kidneys once a year;
• intravenous urography as indicated;
• renal angiography as indicated.

Prevention of the development of vesicoureteral reflux and its complications is its earliest possible diagnosis. This requires antenatal ultrasound to determine the degree of pyelectasis, as well as ultrasound of the kidneys in the neonatal period and in the first year of life.

[ 1 ], [ 2 ]