Editing Pediatrics: Vesicoureteral Reflux (section)

=== Secondary Reflux ===
* '''<span style="color:#ff0000">VUR due to overwhelming the normal function of the UVJ'''
** May be of an anatomic or functional origin in the UVJ, bladder, or bladder outlet
*Reflux is also considered secondary if its absence was documented at some point before its detection.

==== Causes (5) ====

#'''<span style="color:#ff0000">Bladder dysfunction'''
#*Can be of a congenital, acquired, or behavioral nature
#*Often the cause of secondary VUR
# '''<span style="color:#ff0000">Posterior urethral valve'''
#* '''Most common cause of bladder outlet obstruction in infants'''
#** '''In females, anatomic bladder obstruction is rare. The most common structural obstruction in females is from a ureterocele that prolapses into the bladder neck.'''
#* Reflux is present in 48-70% of patients with PUV patients
# '''<span style="color:#ff0000">Neurogenic bladder'''
#* '''<span style="color:#ff0000">Spina bifida, in particular, is at risk for VUR'''
#** '''Special attention for the potential for occult spinal dysraphism is warranted during evaluation of any child with UTI'''
#* '''Urodynamic risk factors for VUR:'''
#*# '''Overactivity'''
#*#* '''Most common urodynamic abnormality associated with VUR in neurologically normal children'''
#*#* Overactive bladder frequently can be responsible for reflux
#*# '''Inadequate or obstructive voiding patterns'''
#*# '''Higher voiding pressures (may be due to inadequate sphincter relaxation)'''
# '''<span style="color:#ff0000">Urinary Tract Infection'''
#* UTIs and their accompanying inflammation can also cause reflux by:
#*# Lessening compliance
#*# Elevating intravesical pressures
#*# Distorting and weakening the ureterovesical junction
# '''<span style="color:#ff0000">Bladder and bowel dysfunction (BBD)'''
#* In older children, acquired abnormalities in bladder and bowel function commonly known as bladder and bowel dysfunction (BBD'')'' have been associated with reflux