[Vesicoureteral reflux and urinary tract infections].

Understanding the role of urodynamic conditions in the bladder with vesicoureteral reflux (VUR) have changed the cause-effect relationship between vesicoureteral reflux and urinary tract infections (UTI) in children. It is not a presence of UTI itself that decides on VUR appearance but accompanying voiding dysfunction. Dysfunctional voiding causes functional urinary tract obstruction which increases intravesical pressure during storage and voiding, and contributes post-voiding residuals. When intravesical pressure exceed ureteric opening pressure the VUR occurs and UTI develops because of urinary stasis. It was noticed that high voiding pressure contributed 90% of VUR in infants. If bladder dysfunction is a fundamental factor in VUR creation, the treatment of VUR should focus on elimination of this dysfunction. Endoscopic subureteric injection could be used as an additional treatment, particularly reducing recurrences of febrile UT.