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2017 ; 58
(Suppl 1
): S54-S58
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Management of vesicoureteral reflux in neurogenic bladder
#MMPMID28612061
Wu CQ
; Franco I
Investig Clin Urol
2017[Jun]; 58
(Suppl 1
): S54-S58
PMID28612061
show ga
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.
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