7.2 Classification

The International Reflux Study Committee introduced a uniform system for the description of reflux, based on the earlier classification by Heikel and Parkkulainen, in 1985. Furthermore, a standardized performance of a voiding cystourethrogram was described to allow comparative studies.

Table 8: Grading system for reflux

Grade I Reflux does not reach the renal pelvis; varying degrees of ureteral dilatation

Grade II Reflux reaches the renal pelvis; no dilatation of the collecting system; normal fornices

Grade III Mild or moderate dilatation of the ureter, with or without kinking; moderate dilatation of the

collecting system; normal or minimally deformed fornices Grade IV Moderate dilatation of the ureter with or without kinking; moderate dilatation of the collecting

system; blunt fornices, but impressions of the papillae still visible Grade V Gross dilatation and kinking of the ureter, marked dilatation of the collecting system; papillary

impressions no longer visible; intraparenchymal reflux

Apart from reflux grading, a description of the position and morphology of the ureteral orifices (normal, stadium, horseshoe or golf-hole orifice) are helpful for planning treatment. The position of an orifice should becategorised as A (trigonal), В, С or D (markedly lateral).