Ureterovesical

Ureterovesical refers to the region where the ureter joins the urinary bladder, most often in reference to the ureterovesical junction (UVJ). This junction marks the distal end of the ureter as it penetrates the bladder wall, typically at the posterior bladder base near the trigone.

Anatomically, the ureter enters the bladder wall at an oblique angle and traverses a submucosal tunnel within the detrusor muscle. This arrangement helps prevent backflow of urine from the bladder into the ureter during bladder filling and voiding. The strength of this anti-reflux mechanism depends on the length of the intramural tunnel and the coordinated contraction of the detrusor.

Clinically, UVJ function is important because reflux of urine from the bladder into the ureter—a condition known as vesicoureteral reflux (VUR)—occurs when the junction is incompetent. VUR can be congenital or acquired and may predispose to recurrent urinary tract infections and, in children, potential kidney damage. Obstruction at the UVJ, ureterocele, or other distal ureteral abnormalities can cause hydronephrosis and impaired drainage.

Diagnosis typically involves imaging studies such as voiding cystourethrography (VCUG) to detect reflux, along with renal ultrasound or nuclear medicine scans to assess kidney drainage. Endoscopic or surgical evaluation may be used for unclear cases or when intervention is indicated. Treatments vary from observation and antibiotic prophylaxis for low-grade reflux to endoscopic injection therapy or ureteral reimplantation for higher-grade reflux or obstruction, aiming to restore a competent ureterovesical junction.