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Clinical presentation, diagnosis, and course of primary vesicoureteral reflux

Authors
Tej K Mattoo, MD, DCH, FRCP
Saul P Greenfield, MD
Section Editors
Laurence S Baskin, MD, FAAP
F Bruder Stapleton, MD
Deputy Editor
Melanie S Kim, MD

INTRODUCTION

Vesicoureteral reflux (VUR) is the retrograde passage of urine from the bladder into the upper urinary tract. The clinical significance of VUR has been based on the premise that VUR predisposes patients to acute pyelonephritis by transporting bacteria from the bladder to the kidney and recurrent urinary tract infection, which may lead to renal scarring, hypertension, and end-stage renal disease (ESRD). However, aspects of this long-held belief have been increasingly questioned. As a result, the clinical impact of VUR and its management remain uncertain and controversial.

The presentation, diagnosis, and clinical course of primary VUR will be reviewed here. The management of primary VUR is discussed elsewhere in the program. (See "Management of vesicoureteral reflux".)

DEFINITION AND PATHOGENESIS

VUR is the retrograde passage of urine from the bladder into the upper urinary tract. It is divided into two categories: primary and secondary based on the underlying pathogenesis.

Primary VUR — Primary VUR, the most common form of reflux, is due to incompetent or inadequate closure of the ureterovesical junction (UVJ), which contains a segment of the ureter within the bladder wall (intravesical ureter). Normally, reflux is prevented during bladder contraction by fully compressing the intravesical ureter and sealing it off with the surrounding bladder muscles.

In primary VUR, failure of this anti-reflux mechanism is due to a congenitally short intravesical ureter (figure 1). The intravesical ureter length may be genetically determined, which may explain the increased incidence in family members of patients with VUR.

                           

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Literature review current through: Mar 2017. | This topic last updated: Mar 07, 2017.
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