Left-sided Reflux , Horseshoe-like Orifice vs. Left-sided Reflux , Golfhole-like Orifice
Left picture: The reason for the recurrent urinary tract infections is a left-sided reflux. In many patients with a horseshoe-like orifice a reflux is present which usually does not disappear with growth because there is no maturation of the vesicoureteral valve which is too short. Right picture: Just as in the picture of the contralateral side, the cause of the urinary tract infections is a left-sided reflux. In this type of shape of the ureteral orifice which is a gross anomaly, an irreversible reflux occurs in more than 90 %. On looking closely a slit-like structure is visible below the already described orifice, corresponding to a second orifice (= complete ureteral duplication). With a slit-like orifice a reflux occurs usually only as a secondary type due to a cystitis or an infravesical obstruction that leads to an impairment of the vesicoureteral valve. In the presented case a complete ureteral duplication is present with reflux in the ureter of the lower kidney, which enters the bladder in a more cranial position.
Left picture: Operative findings in a 5.5-year-old boy who had some work-up examinations due to recurrent urinary tract infections. Following opening of the bladder a left ureteral orifice becomes visible which is shaped like a horseshoe. Notice the hemorrhagic diathesis of the mucous membrane. Right picture: During endoscopy a golfhole-like orifice is recognizable at the top in the picture, corresponding to the left side of a patient with recurrent urinary tract infections.