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(vesicoureteric reflux) A condition in which urine flows retrograde (backward), from the bladder into one or both ureters and then to the renal calyx or kidneys. Urine normally flows anterograde (forward) from the kidneys to the bladder. Vesicoureteral junction is the most distal portion of the ureter, at which it connects to the urinary bladder. It has a one-way valve forming an oblique tunnel of the distal ureter through the bladder wall, that can be compressed as the urine fills avoiding backward flow or reflux. Reflux tends to occur when the ureter enters through the bladder more perpendicularly than obliquely, creating a short tunnel in the wall of the bladder. Because the force of the short bladder wall is insufficient, that lets urine flow backward through the distal ureter. The severity is graded by the presence of dilatation or abnormality of the ureter, pelvis, and calyces (grade I-V). Treatment is meant to minimize infections, as it is infections that cause renal scarring. • Prophylactic antibiotics in newborns and infants who are not potty trained. • Bowel and bladder management in children who are older. Because children who hold their bladder or who are constipated have a greater number of infections than children who void on a regular schedule. • Surgical interventions may be necessary when medical management fails to prevent recurrent urinary tract infections, or if the kidneys show progressive renal scarring.