[1][2] Urine normally travels in one direction (forward, or anterograde) from the kidneys to the bladder via the ureters, with a one-way valve at the vesicoureteral (ureteral-bladder) junction preventing backflow.

In healthy individuals the ureters enter the urinary bladder obliquely and run submucosally for some distance.

Together these features produce a valvelike effect that occludes the ureteric opening during storage and voiding of urine.

This is precipitated by a congenital defect or lack of longitudinal muscle of the portion of the ureter within the bladder resulting in an ureterovesicular junction (UVJ) abnormality.

In this category the ureters' valvular mechanism is initially intact and healthy but becomes overwhelmed by increased bladder pressures associated with obstruction, which distorts the ureterovesicular junction.

[4] VCUG is the method of choice for grading and initial workup, while RNC is preferred for subsequent evaluations as there is less exposure to radiation.

A high index of suspicion should be attached to any case where a child presents with a urinary tract infection, and anatomical causes should be excluded.

A VCUG and abdominal ultrasound should be performed in these cases DMSA scintigraphy is used for the evaluation of the parenchymal damage, which is seen as cortical scars.

[7] Thus VUR not only increases the frequency of UTIs, but also the risk of damage to upper urinary structures and end-stage renal disease.

When medical management fails to prevent recurrent urinary tract infections, or if the kidneys show progressive renal scarring then surgical interventions may be necessary.

Endoscopic injection involves applying a gel around the ureteral opening to create a valve function and stop urine from flowing back up the ureter.

[10] The American Urological Association recommends ongoing monitoring of children with VUR until the abnormality resolves or is no longer clinically significant.

The recommendations are for annual evaluation of blood pressure, height, weight, analysis of the urine, and kidney ultrasound.

[12] As early as the time of Graeco-Roman physician and anatomist Galen described the urinary tract and noted that there were specific mechanisms to prevent the reflux of urine.