Vesicoureteral Reflux (VUR) Classification

Grade I – reflux into non-dilated ureter
Grade II – reflux into the renal pelvis and calyces without dilatation
Grade III – mild/moderate dilatation of the ureter, renal pelvis and calyces with minimal blunting of the fornices
Grade IV – dilation of the renal pelvis and calyces with moderate ureteral tortuosity
Grade V – gross dilatation of the ureter, pelvis and calyces; ureteral tortuosity; papillary impressions

Grades of Ureteral Reflux

Grade	Findings
I	Reflux confined to ureter only
II	Reflux to the level of the intrarenal collecting system without dilatation
III	Grade II + mild or moderate dilatation of the ureter or renal pelvis, but no or only slight forniceal blunting
IV	Grade II + calyceal dilatation and obliteration of the sharp angle of the fornices, but maintainance of the papillary impressions
V	Gross dilatation and tortuosity of the ureter; gross dilatation of the renal pelvis and calices; papillary impressions are no longer visible

Grades I-III: Typically resolve as the child grows

Grades IV-V: Typically require surgery to correct

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Ureteral Filling Defect

Neoplasm

• urothelial neoplasm
• metastasis
• fibroepithelial polyp

Inflammation

• ureteritis cystica
• tuberculosis
• endometreosis

Mobile

• calculus
• slouphed papilla
• blood clot

Ureteral Dilitation

>3mm

• Obstruction: Ureterolithiasis
• Congenital: Chronic vesicoureteral reflux, posterior urethral valves, megaureter, Prune-belly syndrome.
• Infection/Inflammation: UTI, appendicitis, diverticulitis
• Compression: pelvic or abdominal mass

Megaureter: disproportionally enlarged compared to the rest of the renal collecting system

• reflux
• obstruction
• other: congenital megaureter, polyuria, infection

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Lateral Ureteral Deviation

Upper ureter:

• Lymphadenopathy
• Aortic aneurysm
• Retroperitoneal hematoma

Lower ureter

• Pelvic mass, e.g. uterine fibroids

http://www.learningradiology.com/notes/gunotes/ureteraldeviationapgepage.htm

Medial Ureteral Deviation

Upper ureter:

• Retrocaval ureter
• Retroperitoneal fibrosis

Lower ureter:

• Lymphadenopathy
• Iliac artery aneurysm
• Bladder diverticulum
• Post-surgical (esp. AP resection)
• Pelvic lipomatosis

http://www.learningradiology.com/notes/gunotes/ureteraldeviationapgepage.htm