Case Report

Case report-hypothesis: a congenitally lax pubourethral ligament may be a contributing cause of vesico-ureteric reflux

  • ALFONS GUNNEMANN
  • SHU FON MUNA
  • PETER PETROS

Pelviperineology 2011;30(4):113-114

Background:

The hypothesis derives from the field of female stress incontinence. Application of pressure on the anterior vaginal wall at midurethra with a hemostat restores the geometry of the vesicourethral junction and continence.

Methods:

We applied unilateral midurethral pressure during a radiological investigation of a 15 year old patient who had undergone 2 surgeries for ureteric reflux.

Results:

On injection of the dye into the bladder, reflux was noted in the left ureter, and this disappeared within 2-3 seconds after pressure was applied on 2 successive occasions in the midurethral area of the vagina.

Conclusion:

The hypothesis that a musculoelastic mechanism dependent on a competent pubourethral ligament may play a role in vesicoureteral valvular closure, appears to have been confirmed, at least in one case. Hopefully this observation will lead to further studies, and perhaps, new directions for therapy.

Keywords: Vesicoureteric reflux; Musculo-elastic closure; Ureterovesical junction; Pubourethral ligament; Integral Theory.