Vesicoureteral Reflux, Anomaly of Ureteral Orifice vs. Reflux , Ectopic Ureteral Orifice
Left picture: This female infant has a grade 5 reflux of the left side. Its cause is an anomaly of the corresponding ureteral orifice; such a cause may be supsected on the x-ray, if the juxtavesical ureter follows a horizontal course and enters the bladder at a deep level, as shown in the VCUG of another case at the bottom with a bilateral reflux, especially on the left side of the patient. Right picture: Like in the x-ray of the contralateral case, a grade 5 reflux is present here. Nevertheless, this ureter is not visible during filling of the bladder in the left-sided picture, but only during micturation in the right-sided picture. Notice the very deep entrance site in the bladder neck, corresponding to a reflux in an ectopic ureteral orifice. With this location of the orifice of the ureter, continual loss of urine may occur besides recurrent urinary tract infections, which may be misunderstood as diurnal and nocturnal enuresis. Although the merely intermittent obstruction to the outflow from the left ureter causes a dilatation of the left ureter, it is insufficient for a regular continence by the bladder sphincter.
Left picture: During the examination with contrast a reflux became visible in the left kidney as the cause of a febrile urinary tract infection in this female infant of the second trimenon. Right picture: Analogous to the x-ray of the contralateral picture, contrast flows into the left kidney during micturation in this schoolchild with recurrent urinary tract infections.