par Schulman, Claude 
;Denis, Robert ;Gregoir, Willy
Référence Chirurgie Pediatrique, 20, 4, page (239-245)
Publication Publié, 1979
;Denis, Robert ;Gregoir, Willy Référence Chirurgie Pediatrique, 20, 4, page (239-245)
Publication Publié, 1979
Article révisé par les pairs
| Résumé : | The tightness of the ureto-vesical junction depends on the totality of tissue structures which constitute the intramural and terminal ureter. The muscular, collagenous and elastic fibres of the ureter form a network of bundles which, if stretched, close the ureteral orifice. The congenital uretero-vesical reflux is the result of a primary structural insufficiency of the terminal ureter or insufficiency in the vesical bearing point. An embryological interpretation enables the congenital reflux to be explained by an ectopia in the upper ureter resulting from the formation of ureteral cicatrices lower down on the Wolff channel thus leading to an implantation into the bladder which is too high and more lateral which, in turn, inplies a too short intramural ureter trajectory thus predisposing for the reflux. Acquired secondary reflux is observed in the presence of chronic obstructions (neurogenous - low obstruction) and inflammatory lesions, the mechanisms of which are discussed. The maturation of the uretero-vesical junction is seen as a mechanism which intervenes to diminish the probability of secondary reflux and to mitigate in the first few years of life certain lesions of the intramural ureter although growth cannot normalise a severe constitutional ureteral anomaly. |
