Mechanism of vesicoureteral reflux: High detrusor pressure versus low ureteral resistance A narrative review

The objective of this narrative review is to deepen the understanding of vesicoureteral reflux (VUR) by exploring its historical context, current treatments and their outcomes, as well as offering an alternative perspective on this condition.

VUR was first identified in patients with neurogenic bladder following spinal cord injury; it has since been linked to urinary tract infections in newborns and children. The classical theory of primary VUR is that it is caused by the short submucosal ureteral tunnel which leads to low ureteral resistance, thus leading to the development of various surgical methods to increase the ureteral resistance. However, growing evidence indicates that secondary VUR, caused by elevated detrusor pressure, may be a more common cause. Hence, it is critical to identify low urinary tract obstruction during the voiding cystourethrogram or raised detrusor pressure as the cause of the VUR before attempting surgical correction. More studies are necessary to support this position and enhance the treatment outcomes for VUR patients.