الفهرس 
Anatomy of the Ureterovesical JunctionOnly 14 pages are availabe for public view
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Abstract
Vesico-ureteric reflux (VUR) is the retrograde flow of urine from the bladder into the upper urinary tract through an incompetent vesico-ureteric junction. There is evidence for genetic heterogeneity of VUR, suggesting that the most likely mode of inheritance for VUR is dominant, with variable penetrance and expressivity of several genes acting in different families.
Primary VUR is due to incompetence of the vesicoureteric junction, whereas secondary VUR is due to another cause such as neuropathy (spinal cord injury, spina bifida) or obstruction (posterior urethral valves, ectopic ureteroceles).
VUR may be diagnosed prenatally (fetal renal dilatation on pregnancy ultrasound) or following investigation for urinary infection (usually pyelonephritis) . VCUG is the gold standard tool of diagnosis of VUR. ultrasound should remain the first line examination in children with UTI. Moreover, follow-up examinations could be conditioned by the ultrasound and DMSA scintigraphy results.
Reflux of infected urine can lead to pyelonephritis and subsequently renal scarring, hypertension, and renal failure.
There is a strong association among voiding dysfunction, reflux, recurrent infection and constipation. The prompt diagnosis and initiation of tailored medical treatment has been shown to break this cycle and has improved resolution of VUR.
The aim of management is to preserve renal function and prevent UTI.
Endoscopic subureteral injection of tissue-augmenting substances has become an established alternative to long-term antibiotic prophylaxis and surgical intervention in the management of VUR in children.
The indications for surgical intervention include unsuccessful medical management, breakthrough infections on antibiotic prophylaxis , persistent high grade reflux (IV–V), persisting or worsening VUR, and/or significant or progressive renal scarring.