Injection Therapy For Management of VU-Reflux
Definition
The phenomenon of vesicoureteral reflux (VUR) refers to the retrograde passage of urine from the bladder into the ureter(s) and the kidney(s).
Anatomy of the UVJ
As the ureter approaches the bladder, its spirally oriented mural smooth muscle fibers become longitudinal. Two to 3 cm from the bladder, a fibromuscular sheath (of Waldeyer) extends longitudinally over the ureter and follows it to the trigone (Tanagho, 1992 ).
The ureter pierces the bladder wall obliquely, travels 1.5 to 2 cm, and terminates at the ureteral orifice.
As it passes through a hiatus in the detrusor (intramural ureter), it is compressed and narrows considerably. The intravesical portion of the ureter lies immediately beneath the bladder urothelium and therefore is quite pliant; it is backed by a strong plate of detrusor muscle. With bladder filling, this arrangement is thought to result in passive occlusion of the ureter, like a flap valve.
Function of the UVJ:
Opening of the UVJ is achieved by active contraction of the longitudinal muscles within the tunnel.
This draws the extravesical and intravesical points of the intramural ureter closer together, shortens and widens the tunnel, and allows passage of the urine bolus into the bladder
Against which it can be compressed during bladder filling.
So that with filling it does not migrate laterally and experience a shortening of tunnel length.
Ureteral Lock’ or ‘Flap Valve :
Dr.Maamoun Kraiz
