[The physiopathology of vesicoureteral reflux (author's transl)].
The tightness of the ureterovesical junction depends on all the structures composing the terminal and intra-mural ureter. The muscular, collagenic, and elastic fibers of the ureter constitute a mesh net which is stretched during bladder distention and closes the ureteric orifice as a valve. Congenital vesico-ureteric reflux results from a primary structural insufficiency of the terminal ureter or insufficiency of the bladder wall backing. As embryology shows primary reflux can be caused by a high ectopic implantation of the ureter. It results from the development of an ureteric bud appearing in a lower than normal position on the Wolffian duct. This results in a higher and more lateral opening of the ureteric orifice in the bladder which leads to a shorter intra-mural tunnel predisposing it to reflux. Secondary or acquired refluxes are associated with chronic obstructions (i.e. neurogenic bladder--lower urinary tract obstruction), and inflammatory lesions. Their pathogeneses are described and discussed. The maturation of the ureterovesical junction is considered a mechanism involving a reduced likelihood of secondary reflux. It may also, during the first years of life, palliate some minimal structural deficiencies of the intra-mural ureter, but growth and development are unlikely to normalize an ureter presenting at birth with a severe constitutional anomaly.
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011247:Pregnancy; D014513:Ureter / Q000002:abnormalities / Q000254:growth & development / Q000648:ultrastructure; D014517:Ureteral Obstruction / Q000150:complications; D001743:Urinary Bladder / Q000002:abnormalities / Q000254:growth & development; D014718:Vesico-Ureteral Reflux / Q000196:embryology / Q000209:etiology / Q000503:physiopathology*
Die Physiopathologie des primären vesikoureteralen Refluxes.