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Vesicoureteral Reflux

Curtis A. Sheldon MD1
Jeffrey Wacksman MD2
 1 Director, Pediatric Urology, Children's Hospital Medical Center, Cincinnati, OH.
2 Pediatric Urology Associates, Children's Hospital Medical Center, Cincinnati, OH.

Vesicoureteral reflux describes a pathologic event in which urine progresses in a retrograde fashion from the bladder to the ureter and in many cases into the intrarenal collecting system. This pathologic event cannot be treated successfully in isolation. Appropriate care requires meticulous attention to the treatment and prevention of urinary tract infection; correction of any associated voiding dysfunction; and careful attention to such adjuvant care as perineal hygiene, hydration, and treatment of defecation disorders.

Vesicoureteral reflux is classified according to the International grading system demonstrated in Figure 1. Grade I reflux represents retrograde flow into a nondilated ureter only. Grade II reflux refers to the filling of a nondilated ureter and a nondilated renal pelvis. With Grade III reflux, one begins to see a dilatation of the collecting system, but the fornices remain sharp. With Grade IV reflux, the fornices become blunted. Grade V reflux refers to associated massive dilatation and tortuosity of the collecting system.

It is very important to classify ureteral reflux as primary or secondary in its etiology. Primary vesicoureteral reflux refers to a congenital deficiency of the ureteral insertion that results in an ineffective valve mechanism. Secondary vesicoureteral reflux refers to reflux that is caused by either bladder dysfunction or previous surgical intervention.




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