Ureteral reflux in normal infants

Abstract

G u i d o I a n n a c c o n e and P a o l o E m. i l i o P a n z i r o n i Ureteral reflux of the vesical content occurs when the vesico-ureteral valve mechanism is impaired and the intravesical pressure prevails on the pyelo-ureteral excretory pressure. In normal conditions urine backilow from the bladder into the ureters is prevented mainly by the following factors: a) ureteral tonus and contractions, which make the intra-ureteral pressure greater than that of the resting bladder; b) the considerable length and obliquity of the intramural portion of the ureter, which is compressed during contraction of the bladder wall; and c) the existence of a small mucosal valve 'leaf' a t the uretero-vesical junction. Vesico-ureteral reflux is not uncommonly observed in various diseases of the urinary tract (2), whereas it is still a matter of discussion whether it may occasionally occur in healthy subjects.

The radiological investigation of urinary infections in children

“…Iannaccone (1966) found transient reflux very rarely in very small normal babies, and this has also been our experience, but as a rule it should be regarded as an abnormal finding. The cause of reflux is not clearly established.…”

“…It is now well established that reflux is abnormal at any age (Gibson, 1949;Iannaccone & Pazironi, 1955;Jones & Headstream, 1958;Leadbetter, Duxbury & Dreyfuss, 1960;Lich et al, 1964). Iannaccone (1966) found transient reflux very rarely in very small normal babies, and this has also been our experience, but as a rule it should be regarded as an abnormal finding.…”

Do kidneys outgrow the risk of reflux nephropathy?

“…The precise incidence of VUR at birth is uncertain, because the invasive nature of cystography precludes examining normal babies, although it has been estimated at 2% [28]. However, six studies in infants (and some older children), from a time when such research was considered ethical, showed reflux in only 4 of 456 (0.9%) normal subjects, of which 3 were unilateral [29,30,31,32,33,34]. It seems reasonable to round the estimate up to 1% because the few older subjects may have had reflux and outgrown it.…”

Vesico-Ureteric Reflux in the Neuropathic Bladder with Particular Reference to the Development of Renal Scarring

“…In two series of normal newborns subjected to cysto graphy only 1 out of 76 infants was found with transient reflux [7,8]. In another series, which did not specify the technique of cystography used, reflux was found in 55% of infants under 1 year of age [9], Despite this observation …”