The right ureter seen in this intravenous pyelogram shows hydroureter in a patient with vesicoureteral reflux (VUR). Incompetence of the vesicouretreal valve may be due to a congenital malposition or shortening of the intravesicle portion of the ureter. Loss of bladder muscle tone from neuropathy may also lead to VUR. The reflux leads to hydroureter and hydronephrosis; the risk for infection is increased.