RU2348358C1 - Radiodiagnosis method for intermittent vesicoureteral reflux in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: radiopaque medium is introduced in volume of age-determined physiological bladder capacity. Bladder is filled fractionally; at first 50% of physiological bladder capacity is filled. Roentgenography follows. Then physiological bladder capacity is 100% filled. If radiopaque medium regurgitates with ureter 50% filled without radiopaque medium regurgitation with ureter 100%, intermittent vesicoureteral reflux is diagnosed.

EFFECT: higher accuracy of vesicoureteral reflux diagnostics ensured with detection of intermittent forms.

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Description

The invention relates to the field of medicine, namely radiation diagnostics.

Bladder-ureteral reflux (MTCT) is a very dangerous disease that can manifest uncharacteristic symptoms at an early age. Undoubtedly, a considerable part of cases tends to spontaneously cure, either without consequences or with a defect in the form of a persistent expansion of the ureter and pelvis. In another part of patients, undiagnosed and untreated PMR leads to scarring of the renal parenchyma, the development of hydronephrosis with impaired renal function, and in some cases, to the loss of organ function. A frequent complication is the development of renal arterial hypertension. Bilateral reflux can cause renal failure and uremic death (Lopatkin N.A., Pugachev A.G. Bubble-ureteric reflux, M., Medicine, 1990).

Mixed cystourethrography is still considered the most popular method for diagnosing and monitoring PMR. The main advantages of this method are in obtaining information about the details of the structure of the bladder and urethra, and the ability to classify PMR in accordance with accepted criteria. The management tactics for patients with identified MTCT are now clearly developed and used by clinicians. Most patients with MTCT have a wrinkling process in the renal parenchyma. However, this process is detected in patients without proven MTCT, but with persistent symptoms of urinary tract infection. This fact can only be explained from the perspective of the existing so-called “intermittent” PMR (IPMR), which is not diagnosed by generally accepted methods. In works that indicate the existence of IPMR, the following definition is given: IPMR is a reflux that has not been proven by X-ray methods, but has a clinical picture characteristic of reflux - periodically occurring exacerbations of pyelonephritis, leukocyturia (Pugachev A.G., Moskaleva N.G. Intermittent vesicoureteral reflux in children. Urology 2003, No. 2, pp.41-45). Despite the evidence in the literature on the existence of IPMR, most of the questions regarding its diagnosis remain open. The term IPMR itself indicates the transitivity of this pathological condition, and the applied cystourethrography used for diagnosis does not detect intermittent forms of MTCT, and low degrees of reflux are not always noted. According to some authors, a low degree of PMR can also be intermittent, especially with the corresponding clinical picture (Gelfand M.J. et al., Clin. Nucl. Med., 1991 No. 16 (4), p.234-246). Frequent x-ray studies conducted to diagnose IPMR can adversely affect the growing body of the child due to significant radiation exposure.

The prototype is a method of mitotic cystourethrography (Derzhavin V.M. et al. Diagnostics of urological diseases in children, L., Medicine, 1984, p.22-26), which consists in the fact that the radiopaque substance is injected into the bladder simultaneously until the appearance urge to urinate. The first picture is exposed immediately after filling the bladder, the second - during urination. This technique determines the state of PMR as it happens when the bladder is full, and does not reveal refluxes that occur with a small volume of urine and low pressure in the bladder.

The technical result is an increase in the accuracy of diagnosis of vesicoureteral reflux due to the identification of intermittent forms.

The proposed method is illustrated by the following figures: figure 1 - cystogram of a child N. with left-sided low vesicoureteral reflux at 50% full bladder; figure 2 - cystogram of the same child with 100% full bladder, reflux is not determined.

The proposed method is as follows.

Indications: urinary tract infection, enuresis, chronic pyelonephritis.

Contraindications: acute inflammatory processes of the urethra and bladder.

Technique: before the study, the child should empty the bladder. On a x-ray table, a 10% solution of urographin is introduced into the bladder by a sterile catheter in a fractional way. First, 50% of the physiological capacity of the bladder, which is determined relative to age, is filled:

- newborn - 30 ml;

- 1-3 years - 50-90 ml;

- 3-5 years - 100-150 ml;

- 5-9 years - 200 ml;

- 9-12 years old - 200-300 ml;

- 12-15 years old - 300-400 ml.

(Mazurin A.V., Vorontsov I.M. Propaedeutics of childhood diseases, Moscow, "Medicine", 1986, p. 224).

After filling 50% of the physiological capacity of the bladder carry out targeted radiography, the next dose fill 100% of the capacity of the bladder and also perform radiography. If at 50% fullness of the bladder, a reflux of the contrast medium into the ureter is detected, and at 100% full, the reflux of the contrast medium into the ureter is not determined, then intermittent vesicoureteral reflux is diagnosed.

The advantages of the proposed method

This method of cystography makes it possible to accurately identify reflux that occurs even with a low urine content and low pressure in the bladder. The method allows you to see if reflux continues after 50% of the filling of the bladder or if it disappears. The circumstances under which MTCT occurs are important in predicting the possibility of a spontaneous cure. Refluxes that occur when the urine content in the bladder is low and pressure is less prone to spontaneous disappearance than when the urine in the bladder has significant pressure and volume.

The undoubted advantage of this cystography method is its compliance with 2 of the 3 fundamental principles of radiation diagnostics: more accurate diagnosis, accessibility and cost-effectiveness (does not exceed the cost of existing methods), which significantly increases its practical value and extends the diagnostic capabilities of x-ray examination of urological patients.

We give an example of clinical use of the proposed method.

Example. Patient N., 6 years old, turned to the children's clinic of GB No. 3 with complaints of enuresis and changes in urine tests for a long time. The examination was conducted: a clinical blood test - without pathological changes. General urine analysis - leukocyturia and proteinuria. Ultrasound examination of the kidneys - no pathological changes were detected. Radiography was performed according to the described procedure. At 50% filling of the bladder (100 ml of contrast medium), an X-ray diffraction of the contrast medium into the left ureter at the level of the pelvic cystoid was determined (Fig. 1). On the x-ray at 100% full bladder (200 ml), the injection of contrast medium into the ureters was not determined (figure 2). Diagnosed with left-sided intermittent vesicoureteral reflux. The patient was sent to DRKB.

Claims (1)

A method for x-ray diagnosis of vesicoureteral reflux (PMR), including the introduction of a radiopaque substance in the volume of the physiological capacity of the bladder, determined relative to age, and radiography of the bladder, characterized in that the bladder is filled fractionally, first fill 50% of the physiological capacity of the bladder, an x-ray of the bladder is performed, then 100% of the physiological capacity of the bladder is filled and when determining the reflux of the contrast agent in the urine an intermittent PMR is diagnosed at 50% filling and the absence of reflux of the contrast agent into the ureter at 100% filling.

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