Characteristics of Normal and Refluxing Ureterovesical Junctions

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Abstract
To quantitatively define the mechanism of ureterovesical junction (UVJ) competence and vesicoureteral reflux, we measured ureteral pressures using a continuously perfused catheter with a single side opening. Studies were performed under general anesthesia on 11 competent and 9 refluxing UVJ. The amplitude of ureteral contractions was essentially the same in refluxing and nonrefluxing systems, but peristaltic frequency was significantly lower in the presence of even the milder forms of reflux. With the bladder empty, a high pressure zone was observed at the UVJ in both refluxing and nonrefluxing systems, with no significant pressure difference between the 2 groups. No relaxation was observed during urine transport across the UVJ. With bladder filling, a greater increase in profile pressure occurred at the UVJ of nonrefluxing than refluxing systems. The UVJ bladder pressure gradient of nonrefluxing systems increased with bladder filling, whereas the gradient in the refluxing systems decreased. Refluxing ureters apparently have a decreased peristaltic frequency and fail to maintain a pressure gradient at the UVJ with bladder filling.