Ureterovesical Junction and Waldeyer's Sheath: A Narrative Review Applied to Vesicoureteral Reflux.

Abstract

The ureterovesical junction (UVJ) is a specialized anatomical and functional unit responsible for maintaining unidirectional urinary flow from the ureter into the bladder. Dysfunction at this junction may lead to vesicoureteral reflux (VUR), obstruction, recurrent infections, and potential renal damage. The aim of this review is to present a narrative overview of the historical evolution in the understanding of the UVJ and to summarize key surgical principles, techniques, and contemporary controversies in its management. A narrative analysis of historical anatomical literature, landmark surgical innovations, and contemporary management strategies for UVJ pathology was performed. Emphasis was placed on seminal contributors and the evolution of surgical techniques. Early anatomical descriptions established the importance of the intramural ureter and trigonal anatomy. With the advent of cystography, VUR became recognized as a major pediatric urologic condition. Despite technological advances, the fundamental surgical principles governing UVJ reconstruction remain unchanged: adequate submucosal tunnel length, preservation of vascularity, and tension-free reimplantation. Ongoing advances in minimally invasive surgery and biomaterials continue to refine management strategies.