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Hypothesis - a congenitally lax pubourethral ligament may be a contributing cause of vesicoureteral reflux.

Gunnemann A, Petros P - Cent European J Urol (2012)

Bottom Line: Application of pressure on the anterior vaginal wall at midurethra with a hemostat restores the geometry of the vesicoureteral junction and continence.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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Klinikum Lippe, Detmold, Germany.

ABSTRACT

Introduction: 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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus

Radiopaque dye injected into the bladder flows into the left ureter (L). The hemostat (H) is inserted, but no pressure has yet been exerted.
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Figure 0002: Radiopaque dye injected into the bladder flows into the left ureter (L). The hemostat (H) is inserted, but no pressure has yet been exerted.

Mentions: There was no reflux observed into the right double system, but ureteric reflux was seen on the left side (Fig. 2). On cystoscopy, the urethra was normal, with no mechanical obstruction evident at the meatus, or anywhere along its length. Large complex trabeculae were seen in the bladder wall. The left orifice was “horseshoe” in shape, according to the classification of Lyon, and laterally displaced. When the forceps were unilaterally applied retropubically at midurethra Fig. 1, within 2-3 seconds the reflux had disappeared as documented fluoroscopically (Figs. 2 and 3) [3]. This was repeated on a 2nd occasion with the same results.


Hypothesis - a congenitally lax pubourethral ligament may be a contributing cause of vesicoureteral reflux.

Gunnemann A, Petros P - Cent European J Urol (2012)

Radiopaque dye injected into the bladder flows into the left ureter (L). The hemostat (H) is inserted, but no pressure has yet been exerted.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921757&req=5

Figure 0002: Radiopaque dye injected into the bladder flows into the left ureter (L). The hemostat (H) is inserted, but no pressure has yet been exerted.
Mentions: There was no reflux observed into the right double system, but ureteric reflux was seen on the left side (Fig. 2). On cystoscopy, the urethra was normal, with no mechanical obstruction evident at the meatus, or anywhere along its length. Large complex trabeculae were seen in the bladder wall. The left orifice was “horseshoe” in shape, according to the classification of Lyon, and laterally displaced. When the forceps were unilaterally applied retropubically at midurethra Fig. 1, within 2-3 seconds the reflux had disappeared as documented fluoroscopically (Figs. 2 and 3) [3]. This was repeated on a 2nd occasion with the same results.

Bottom Line: Application of pressure on the anterior vaginal wall at midurethra with a hemostat restores the geometry of the vesicoureteral junction and continence.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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Klinikum Lippe, Detmold, Germany.

ABSTRACT

Introduction: 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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus