By George W. Kaplan, Irene M. McAleer (auth.), Dix P. Poppas MD, Alan B. Retik MD (eds.)
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IV. Pediatric Urology 36 Ureteral Duplications and U reteroceles Emilio Merlini and Douglas A. Canning 4 Abnormal development of the ureteric bud causes both ureteral duplication and ureterocele. Proximal branching of the ureteric bud is the cause of incompletely duplicated or bifid ureters, but comp letely duplicated ureters are caused by the development of two separate ureteric buds from the mesonephric duct. Ureteroceles are probably the result of abnormal distal ureteral canalization of Chwalla's membrane.
The embryologic relationship between the distal ureter and bladder during the first few weeks of gestation determines the development of the UVJ. A ureteral bud that has an abnormally caudal takeoff from the mesonephric duct inserts into the bladder at a lateral and cranial position relative to normal. This relationship offers an embryologic explanation for primary reflux . functional bladder outlet obstruction, including myelodysplasia and posterior urethral valves. This oblique view from the voiding phase of a VCUG depicts the typical dilated posterior urethra (U) and posteriorly placed pinpoint luminal opening of the urethra at the proximal extent of classic type I (Young's classification) posterior urethral valves (arrow).
The International Classification System established by the International Reflux Study provides the current standard for grading reflux and is based on the anatomic appearance of contrast in the ureter and renal collecting system during VCUG . A, Grade I: reflux of ATION radiopaque contrast into a nondilated ureter. B, Grade II: reflux of contrast into nondilated ureter, renal pelvis, and calyces. C, Grade III: reflux into ureter, renal pelvis, and calyces with mild to moderate dilation of the collecting system.