Investig Clin Urol.  2017 Jun;58(Suppl 1):S54-S58. 10.4111/icu.2017.58.S1.S54.

Management of vesicoureteral reflux in neurogenic bladder

• Wu CQ
• Franco I

• KMID: 2379896
• DOI: http://doi.org/10.4111/icu.2017.58.S1.S54

Abstract

Vesicoureteral reflux (VUR) is a significant risk factor for pyelonephritis and renal scarring. VUR can occur through a defective ureterovesical junction (UVJ) or an overwhelmed normal UVJ mechanism such as in bladder dysfunction of congenital, acquired, or behavioral etiology. There are numerous causes for the development of a neurogenic bladder from spinal dysraphisms to spinal cord trauma and even centrally based abnormalities in children with apparently normal motor function (inappropriately termed nonneurogenic neurogenic bladder). The foundation of managing reflux in these neurogenic bladders is to maintain low bladder pressures which will commonly mean that compliance will be normal as well. There have been several publications that have shown that if bladder pressures are lowered simply with clean intermittent catheterization and medications that the reflux can resolve spontaneously. Alternatively, the patients that are in need of bladder augmentation can have spontaneous resolution of their reflux with the resulting increase in capacity. Surgical intervention is called for when bladder capacity is adequate and the reflux persists or if it is part of a larger operation to increase capacity and to manage outlet resistance. In some instances, reimplantation is necessary because the ureters interfere with the bladder neck procedure. Aside from open and robotic surgical intervention the use of endoscopic injectable agents is beginning to become more popular especially when combined with intravesical botulinum toxin A injections. Great strides are being made in the management of patients with neurogenic bladders and we are seeing more choices for the urologist to be able to manage these patients.

Keyword

Cohen cross trigonal reimplant; Neurogenic urinary bladder; Type A botulinum toxins; Vesicoureteral reflux

MeSH Terms

Botulinum Toxins
Child
Cicatrix
Compliance
Humans
Intermittent Urethral Catheterization
Neck
Pyelonephritis
Replantation
Risk Factors
Spinal Cord Injuries
Spinal Dysraphism
Ureter
Urinary Bladder
Urinary Bladder, Neurogenic*
Vesico-Ureteral Reflux*
Botulinum Toxins

Figure

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  Fig. 1 Algorithm for management of vesicoureteral reflux (VUR) in neurogenic bladder. CIC, clean intermittent catheterization.

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