A View on the Anatomy of the Ureterovesical Junction

Abstract

Macro- and microscopic dissection of 8 adult and 2 fetal human bladders was undertaken in two directions as part of a study to evaluate ureterovesical junction function. In the trigonal region the detrusor muscle consists of 3, more or less triangular layers. Both ureters are only loosely enveloped by a fibromuscular sheath of mainly bladder origin. This design allows for easy movement of the ureters on their oblique course through the bladder wall. The ureteral muscle fibers play only a minor part in the sheath or join the detrusor muscle. The majority fan out to end at the bladder mucosa or intermingle with fibers originating from the opposite ureter. Since an intricate muscular structure can be demonstrated, an active anti-reflux muscular component in the normal human bladder seems plausible. A classic ureteral sphincter mechanism does not exist. Our findings are discussed and compared with data from the literature.

Doppler waveforms of the ureteric jet: an overview and implications for the presence of a functional sphincter at the vesicoureteric junction

“…In the third theory the VUJ is considered to be able to act as a sphincter. Noordzij and Dabhoiwala [33] have proposed a sphincteric function for the VUJ which might be activated by the intrinsic muscular meshwork of the trigonal region of the bladder complementing a purely passive antireflux mechanism.…”

Localization of nitric oxide synthase and haemoxygenase, and functional effects of nitric oxide and carbon monoxide in the pig and human intravesical ureter

“…A passive flap-valve mechanism has been advocated (Bro-Rasmussen, 1965). However, it has also been proposed that the nerves of the smooth muscle of the IVU control partly (Tanagho, 1965) or totally (Noordzij, 1993) the valvular activity of the UVJ. In the human UVJ, several populations of nerve fibers have been defined with respect to their content of potential transmitter substances (Edyvane, 1995).…”

Morphological study of the ureterovesical junction in children

“…Radmayr et al. (), Rasouly & Lu () and Noordij & Dabhoiwala () analysed the anatomy and function of the vesicoureteral junction's components and their anti‐reflux mechanism, and pointed out many misunderstandings and misinterpretations in the literature dealing with physiological fetal development. Separate parts of the vesicoureteral junction were analysed by them, and lead to the conclusion that primary vesicoureteral reflux is caused by abnormalities in the vesicoureteral junction and also insufficiency of circular muscles of the ureter.…”