Causes Number 2 (Reflux)

Figure harn_2En_n.jpg: Diagrammatic presentation of the factors enabling the competence of the vesicoureteral valve. These factors are 1) the submucous course of the ureter; 2) the anchorage of the longitudinal muscles of the ureter in the trigonum; 3) the site of passage of ureter through the bladder muscles; 4) an intraluminal ureter pressure that exceeds the intraluminal bladder pressure. Depending on the cause and the type of reflux, several or a single one of these factors or mechanisms stand in the forefront. For instance, in case of delayed maturation of the vesicoureteral valve, in case of cystitis, or in case of infravesical obstruction; in the latter a turning back of the pressure gradient occurs due to the increased intraluminal bladder pressure.