Objective: To analyze whether it is correct to use endoscopic treatment via bulking agents of vesicoureteral reflux (VUR) seen on video urodynamics with non-simultaneous involuntary detrusor contraction in chronic spinal cord injury (SCI) patients with neurogenic detrusor overactivity (NDO). Methods: A retrospective study was performed with a cohort of 76 patients (age 48.9 ± 14.4 years) (mean ± standard deviation) of both sexes with chronic SCI who underwent endoscopic treatment of VUR during the years 2008 to 2011. Patients were subjected to clinical examinations and video urodynamic studies preoperatively and 22 ± 11.4 months after the intervention. Results: Resolution of VUR was achieved in 46 cases (61%). Cured patients had a statistically significant younger age and showed stress urinary incontinence more frequently. On the contrary, a greater grade of VUR, presence of bilateral reflux and presence of NDO were positively associated with treatment failure. The variables that independently influenced the cure of the reflux were NDO and reflux grade. Conclusions: The failure rate was high in patients with NDO, even though the reflux was not synchronous with involuntary detrusor contraction, and therefore these patients should have NDO eradicated before doing any anti-reflux procedures.

Keywords:
Vesicoureteral reflux, Video urodynamics, Endoscopic surgical procedures, Spinal cord injury
1.
Jorgensen TM: Pathogenetic factors in vesicoureteral reflux. Neurourol Urodyn 1986;5:153-183.
2.
Salinas Casado J, Martín García C, Virseda Rodríguez M, Ramírez Fernández JC, Silmi Moyano A: Actualización videourodinámica de la clasificación del reflujo vesicoureteral en el niño [Video urodynamic update of the vesicoureteral reflux classification in children]. Arch Esp Urol 2008;61:180-184.
3.
Stöhrer M, Blok B, Castro-Diaz D, Chartier-Kastler E, Del Popolo G, Kramer G, Pannek J, Radziszewski P, Wyndaele JJ: EAU guidelines on neurogenic lower urinary tract dysfunction. Eur Urol 2009;56:81-88.
4.
Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE: International system of radiographic grading of vesicoureteral reflux. International Reflux Study in Children. Pediatr Radiol 1985;15:105-109.
5.
Moore K, Bolduc S: Treatment of vesicoureteral reflux in adults by endoscopic injection. Urology 2011;77:1284-1287.
6.
Sugiyama T, Hanai T, Hashimoto K, Umekawa T, Kurita T: Long-term outcome of the endoscopic correction of vesico-ureteric reflux: a comparison of injected substances. BJU Int 2004;94:381-383.
7.
Haferkamp A, Möhring K, Staehler G, Gerner HJ, Dörsam J: Long-term efficacy of subureteral collagen injection for endoscopic treatment of vesicoureteral reflux in neurogenic bladder cases. J Urol 2000;163:274-277.
8.
Yasui T, Akita H, Sasaki S, Hayashi Y, Kohri K: Endoscopic injection of Teflon for correction of primary vesicoureteral reflux in children. Int J Urol 1997;4:349-351.
9.
Arce J, Angerri O, Caffaratt J, Garat JM, Villavicencio H: Efficiency of endoscopic treatment for vesico-ureteric reflux in adults. BJU Int 2008;103:71-74.
10.
Basok EK, Yildirim A, Atsu N, Gocer S, Tokuc R: Endoscopic treatment of vesicoureteral reflux with polydimethylsiloxane in adults: do location and appearance of the ureteric orifice have a role in the success rates? Urol Int 2008;80:279-282.
11.
Ponce Díaz-Reixa J, Sánchez Rodríguez-Losada J, Alvarez Castelo L, Romero Selas E, Fernández Rosado E, González Martin M: Reflujo vesicoureteral en pacientes lesionados medulares. Análisis estadístico de resultados en el tratamiento [Vesicoureteral reflux in spinal cord injured patients. Treatment results and statistical analysis]. Actas Urol Esp 2007;31:366-371.
12.
Kraft KH, Molitierno JA Jr, Dewhurst L, Geers C, Gunderson K, Scherz HC, Kirsch AJ: Is endoscopic injection therapy a reasonable treatment option for low-grade vesicoureteral reflux in association with overactive bladder? Urology 2011;78:675-678.
13.
Willemsen J, Nijman RJ: Vesicoureteral reflux and videourodynamic studies: results of a prospective study. Urology 2000;55:939-943.
14.
Yokoyama O, Ishiura Y, Seto C, Uchibayashi T, Ohkawa M: Endoscopic treatment of vesicoureteral reflux in patients with myelodysplasia. J Urol 1996;155:1882-1886.
15.
Polackwich AS, Skoog SJ, Austin JC: Long-term followup after endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid copolymer in patients with neurogenic bladder. J Urol 2012;188(4 suppl): 1511-1515.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.