Vesicoureteral Reflux vs. Obstructive Megaureter, Iuxtavesical Ureteral Stenosis
Left picture: The diagnosis for this girl is a bilateral vesicoureteral reflux (reflux); on the left side grade 2 to 3, and on the right side grade 4 to 5. Because the urethra as well as the bladder are visible, a voiding cystourethrography is present here (= VCUG). The bladder which was filled with contrast by a catheter voids to a lesser degee to the outside; the main amount of contrast flows back to the upper urinary tracts through an incompetent vesicoureteral valve. Right picture: In this boy a bilateral obstructive megaureter in a juxtavesical ureteral stenosis is present; on the right side grade 2, and on the left side grade 3. There is no urine visualized by contrast in the bladder because the contrast was introduced by a ureteral catheter in the upper urinary tracts retrogradely (notice the fine structure on the right side in the bladder), and due to the prevesical obstruction no substantial amount passes into the bladder within reasonable time.
Left picture: During the examination with contrast the upper urinary tracts are completely filled from the calices to the prevesical ureter in this 3-month-old girl; they are more dilated on the right than on the left side, and the right pyelocaliceal system is deformed. Right picture: In this infant of the first trimenon both dilated upper urinary tracts are pictured by means of contrast. The pyelocaliceal system is more deformed on the left than on the right side. Notice the grotesque dilatation of both prevesical ureteral segments similar to the head of a snake.