Vesicoureteral reflux-stenosis: an approach to diagnosis and treatment

Abstract

Vesicoureteral reflux-stenosis is a malformation of the urinary system in which reflux is combined with a narrowing of the distal ureter at the site of its confluence with the bladder. At the same time, the diameter of the lumen of the formed rigid section of the narrowed ureter is sufficient for the occurrence of reflux, but not enough for normal emptying of the upper urinary tract, which leads to the development of a reflux megaureter. Histologically, the wall of the narrowed ureter is characterized by the presence of fibrosis, atrophy of the submucosal layer and the absence of neuromuscular elements of the ureterovesical junction. Diagnosis of reflux stenosis should include mycological cystography and intravenous excretory urography, the results of which, in addition to reflux itself, often determine the “beak symptom” – narrowing in the distal ureter; cystoscopy, which reveals narrow ureteral mouths without peristalsis; computed tomography with contrast enhancement; ultrasound examination of the kidneys and ureters on a urethral catheter with a diuretic test – an increase in the volume of the upper urinary tract by more than 30% of the initial values indicates the presence of stenosis. To clarify kidney function, the study is supplemented with static nephroscintigraphy. The most preferable option is a staged surgical treatment – the narrowed distal ureter is bujured and a ureteral stent is installed for a period of 1 month. While maintaining reflux, according to the data of microvascular cystography, endoscopic plastic surgery of the ureteral mouth is performed. In case of ineffectiveness of minimally invasive interventions, they proceed to Cohen’s neoimplantation of the ureter with resection of the distal ureter and, if necessary, with straining of the enlarged ureter.