The Cinecystogram and Reflux during Childhood

SUMMARY On initiating micturition in urinary bladders associated with reflux, there appears to be a normal descent of the bladder neck and pelvic floor. Except in cases of neuro‐muscular incoordination and uncommon urethral lesions, the intravesical pressures and urethra appear normal. The ureters also show peristaltic activity. The primary fault appears to lie in the distal 2 cm. of the ureter, that is, where it passes obliquely through the bladder wall. Because of the variation in the time and quantity of reflux, there may be some secondary, as yet undefined, factor involved. This review confirms previously held impressions that the cause of reflux in the vast majority of otherwise normal children is in the faulty insertion of the ureter into the bladder. The ureters associated with reflux pass straight through the bladder wall and the ureteric orifice “gapes” when seen on cystoscopy. There is no oblique passage of the ureter through the bladder wall. The mechanisms of micturition and the pressure relationships are perfectly normal in these children. It is impossible to exclude even gross reflux on an excretory pyelogram. This fact is not yet fully appreciated. Reflux was also p