par Schulman, Claude ;Gregoir, Willy
Référence Der Urologe, 16, 3, page (118-123)
Publication Publié, 1977
Article révisé par les pairs
Résumé : The tightness of the ureterovesical junction depends on all the structures composing the terminal and intramural 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 vesicoureteric reflux results from a primary structural insufficiency of the terminal ureter or insufficiency of the bladder wall backing. Embryology shows that a primary reflux can be caused by a high ectopic implantation of the ureter. It results from the development of a 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 intramural 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. The pathogenesis of the various forms are described and discussed. The maturation of the ureterovesical junction is considered to be 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 intramural ureter, but growth and development are unlikely to normalize a ureter presenting at birth with a severe constitutional anomaly.