Mechanism of vesicoureteric reflux prevention and evaluation of anti-reflux operation

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Present study shows that vesicoureteric reflux was prevented by closing of intramucosal ureteral lumen. Ultrasound examination revealed that intramucosal ureteral lumen was closed except urine expulsion from ureteral orifice by peristalsis. Incomplete closing of intramucosal ureteral lumen was occurred by deficit of mucosal and/or muscle layers.VUR was classified into two groups-reversible VUR and irreversible VUR-according to responsibility to treatment. The reversible VUR was cured spontaneously or by conservative treatment. The irreversible VUR which did not respond to medical treatment was due to inflammatory sclerotic changes of mucosal and muscle layers.In sixteen cases results of the anti-reflux operation were evaluated. The degree and existence of VUR renal function, degree of urinary tract dilatation, proteinuria and urinary tract inefection were observed on each case before and after operation. Fourteen out of 16 cases were estimated to be successful, on the other hand 2 cases were estimated to be unsuccessful. The one unsuccessful case received hemodialysis due to progressive deteriorated renal function, and another case developed recurrence of VUR.In two cases urine flow around ureteral orifice was evaluated by color doppler technique before and after anti-reflux operation. Downward flow was detected, but upward flow was not detected. The evaluation of urine flow around ureteral orifice by color doppler technique might be useful method for the detection of VUR.