title: Hypothesis - a congenitally lax pubourethral ligament may be a contributing cause of vesicoureteral reflux.
abstract: BACKGROUND
  The hypothesis derives from the field of female stress incontinence. Application of pressure on the anterior vaginal wall at midurethra with a hemostat restores the geometry of the vesicoureteral junction and continence.
  
  
  METHODS
  We applied unilateral midurethral pressure during a radiological investigation of a 15-year-old female patient who had undergone 2 surgeries for ureteric reflux.
  
  
  RESULTS
  On injection of the dye into the bladder, reflux was noted in the left ureter, and this disappeared within 2-3 seconds after pressure was applied on 2 successive occasions in the midurethral area of the vagina.
  
  
  CONCLUSIONS
  The hypothesis that a musculoelastic mechanism dependent on a competent pubourethral ligament may play a role in vesicoureteral valve closure appears to have been confirmed, at least in one case. Hopefully this observation will lead to further studies, and perhaps, new directions for therapy.
authors.affiliation: Department of Urology, Klinikum Lippe, Detmold, Germany.
authors.forename: Alfons
authors.initials: A
authors.lastname: Gunnemann
authors.affiliation: University of New South Wales, Academic Department of Surgery, St. Vincent's Clinical School, Sydney, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Petros
keywords: vesicoureteral reflux