Causes Number 1 (VUR)

harn_1a_n.jpg: Drawing of the course of the ureter through the wall of the bladder; the left side depicts the normal situation with the clearly recognizable submucous course of the ureter. The right side shows an anomaly of the vesicoureteral valve with an unrecognizable submucous course of the ureter (M. Bettex). A possible cause of reflux is a congenital malformation of the vesicoureteral valve; the drawing shows that one factor of effectiveness of the vesicoureteral valve is defective, namely the submucous course of the ureter. harn_1b_n.jpg: Shape of the orifice of the ureter during cystoscopy in a 2.3-year-old girl: Visible on the left side is a semi-empty and on the right side a full bladder; the orifice remains open. In case of reflux due to a malformation of the vesicoureteral valve the following findings during endoscopy may be observed: Lateralization of the orifice, which means that the orifice lies lateral to its usual site in the trigonum, e.g. in comparison to the normal site of the contralateral side; and/or a golf hole orifice which means that the orifice has not the usual slit- or horseshoe-like shape, but an abnormal shape, and that the orifice is constantly open independent of bladder filling and peristalsis of the ureter.