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Various Concepts in the Aetiology of Recurrent Urinary Tract Infections in Girls
Abstract
The important role that vesico-ureteric reflux plays in the perpetuation of urinary tract infections has become increasingly evident. There is general agreement on the importance of its early detection and treatment. It is also evident that the vast majority of children with reflux have congenital anatomical abnormalities of the ureterovesical junction. There are, however, controversial views on the subject, and various concepts of the mechanism responsible for the competency of the ureterovesical junction. The important anatomical factors are the length and diameter of the intravesical (submucosal) ureter, the ratio of length to width, the pliability of the roof of the submucosal ureter and the integrity of the underlying detrusor. Reflux is not a single disease and the aetiology may vary. It is but a radiographic sign common to several pathological processes. There is also still considerable debate as to whether primary reflux can maturate and disappear with age. This has an important bearing on the formulation of any prognostic and therapeutic programme.
