← All decks
Paediatric Surgery
Anatomical and Functional Basis of Vesicoureteral Reflux
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
7 sections · 57 slides
Setting the Scene
What reflux is and why it matters
- What is vesicoureteral reflux?
- Why VUR has been controversial
- Primary vs secondary reflux: one spectrum
- The central question of this topic
Normal Anatomy of the UVJ
The flap-valve that prevents reflux
- The flap-valve principle
- Normal one-way flap valve at the UVJ
- A short tunnel that fails to seal and refluxes
- Passive valve, not an active muscle sphincter
- How the ureteral muscle is built
- Intramural and submucosal segments
- The trigone and the interureteric ridge
- Where do the trigonal fibers really come from?
- Waldeyer's sheath: a contested wrapping
- Why Waldeyer's sheath matters to the surgeon
- Paquin's 5:1 rule: the enduring dogma
- The trigone and intravesical ureter
- Normal ureter and orifice measurements
- What Paquin actually measured
Innervation of the UVJ
Nerves near the junction and why they matter in surgery
- Mapping the nerves around the ureter and bladder
- These are motor nerves to the detrusor
- Where the nerve supply sits relative to the UVJ
- Proof that dissection can denervate the bladder
- The junction keeps maturing after birth
Anatomical Findings in VUR
Short tunnels, misplaced orifices, and telltale shapes
- The logical anatomical setup for reflux
- The embryology: an abnormal ureteric bud
- Orifice shape predicts reflux
- The four cystoscopic types of ureteral orifice
- Shape and position together grade the risk
- A gaping golf-hole orifice in high-grade reflux
- Dynamic hydrodistention: testing the valve live
- Grade H3 hydrodistention of the orifice
- Why hydrodistention grading is useful
Histological Findings in VUR
What the refluxing ureter looks like under the microscope
- From plain stains to immunohistochemistry
- Signs of ischemia and poor cell coupling
Bladder Function and VUR
The functional half of the story
- Bladder dysfunction travels with reflux
- Normal infant bladders run at high pressure
- The normal infant voiding pattern
- Urodynamic patterns in infants with high-grade VUR
- Dilated bladder and overactivity
- Evidence from the Swedish Reflux Trial
- Older children: pressure overpowers the valve
- Dysfunctional elimination and the payoff of treating it
Pulling It Together
Anatomy and function as one continuum
- Three ideas to carry away
- Why does a normal ureterovesical junction prevent reflux without any active muscle contraction?
- References (1/4)
- References (2/4)
- References (3/4)
- References (4/4)
- Pediatric Surgery and Pediatric Urology