1Primary vesicoureteral reflux is caused by weaknesses in the development of the ureterovesical junction. Due to various reasons, the function of the ureterovesical junction is abnormal, causing the phenomenon of vesical urine refluxing back into the ureter, which is called vesicoureteral reflux. This disease can be divided into congenital and acquired types, with children mostly congenital and the incidence rate is higher than that of adults. Adults are mostly caused by urethral and bladder lesions, with more women than men. Vesicoureteral reflux can cause hydronephrosis of the ureter and kidney, secondary infection and calculus, and damage kidney function. The treatment effect of this disease is good, and the cure rate of surgery is95% above.
2Vesicoureteral reflux can cause upper urinary tract bacterial infection, occasionally increased intrarenal pressure, damage kidney function, and cause reflux mainly due to congenital developmental defects at the vesicoureteral junction. Reflux can also occur in children with normal anatomical and functional junctions but with bladder outlet obstruction, increased intravesical pressure, and neurogenic bladder. Bacteria in the lower urinary tract can easily pass through reflux to the upper urinary tract, causing renal parenchymal infection, renal scarring, and renal function damage. Chronic increased storage and voiding pressure (>40cmH2O) can cause increased intrarenal pressure leading to reflux. Vesicoureteral reflux can cause lumbar and abdominal pain, persistent or recurrent urinary tract infections, difficulty urinating or pain in the lower back during urination, frequent urination, urgency, and symptoms of renal insufficiency. It can also cause pyuria, hematuria, proteinuria, and bacteriuria. Intraurethral and voiding cystoureterography can clearly identify reflux and determine the presence of bladder outlet obstruction, which can be resolved by surgery. Direct isotope cystography can also determine whether there is reflux, and prophylactic antimicrobial therapy can naturally disappear after several months to several years of long-term use. If prophylactic antimicrobial therapy is ineffective, the best option is to perform ureterovesical reimplantation surgery when renal scarring progresses. If reflux is combined with high-pressure storage and voiding of the bladder, drugs and/or behavioral therapy to reduce intravesical pressure. Sometimes reflux may be resolved accordingly, otherwise, reimplantation surgery is necessary. Reimplantation surgery can almost always cure reflux and reduce the incidence of pyelonephritis, as well as the incidence and mortality rate of secondary kidney diseases due to reflux and infection.
