ABSTRACT
Galen and Leonardo da Vinci were the first to propose that normal UVJ allowed unidirectional flow of
urine into the bladder and that VUR might be abnormal in humans.1,2 In 1893, Pozzi reported that VUR could occur in humans after noting an unexpected urine leakage from the accidentally severed ureter during a pelvic gynecologic procedure.3 The systematic identification of VUR came as the result of technologic advances in contrast radiography – voiding cystourethrography (VCUG). Initially, VUR was not thought to be a significant clinical problem for humans, although Bumpus speculated in 1924 that VUR was related to UTI and that in children, unlike adults, VUR was not associated with other urinary tract pathology.4 In 1930, Campbell found VUR in 12% of over 700 VCUGs but assumed that there was other underlying pathology as the cause of VUR.5 In 1944, Prather proposed that VUR was abnormal in children,6 and this notion gained increasing acceptance, after accumulating evidence suggested that VUR was typically absent in normal neonates and children. The modern era of clinical VUR management was ushered in by Hutch’s observation that VUR and pyelonephritis might be causally related in paraplegic patients.7 Hodson, applying Hutch’s concept to children, noted that VUR was more common in children with UTI and renal parenchymal abnormality.8,9 Other clinical and experimental observations soon followed, providing the anatomic and functional basis for the UVJ mechanism and the etiology of VUR.
