A 5-year-old girl comes to your clinic because she has
had several urinary tract infections. During these episodes
she has fever, nausea, dysuria (painful urination) and left
flank pain. Her renal and bladder ultrasound shows two
normal kidneys. You order this voiding cystourethrogram.
This periureteral diverticulum causes vesico-ureteral reflux because it prevents the normal valve mechanism of the distal ureter. When the child voids, the increased pressure within the bladder causes the entire distal ureter and some of the adjacent bladder mucosa to herniate. After her ureter was surgically reimplanted into her bladder she had no more reflux.
