Vesicoureteral reflux in spinal cord injury patients

Park, Jin; Park, Won Hee

Abstract

We reviewed 39 spinal cord injury patients with vesicoureteral reflux (VUR) (S4 ureters) and 35 without VUR (69 ureters). with average follows-up of 4.9 years (1-13 years) since the development of VUR. We performed urinalysis, urine culture, serum BUN and creatinine, IVP and voiding cystourethrography. We compared the results of above tests between two groups. The level and the completeness of spinal cord injury, bladder capacity, residual urine. bladder diverticulum, bladder stone, the method of urinary drainage, before development of VUR were considered as risk factors. Small bladder capacity and large amount of residual urine were significant risk factors. In VUR group the incidence of renal scarring and those of pyelonephritis and hydroureteronephrosis were increased compared with those of non-reflux group. If pyelonephritis was accompanied with VUR, the incidence of renal starring was increased. When the degree of VUR was mild at the development of VUR, VUR became stable or improved with medical treatment, but when severe. VUR didn`t become improved or even was aggravated with medical treatment. VUR disappeared in all cases with surgical treatment. Previously impaired renal function didn`t improve regardless of treatment methods. In conclusion, we endeavor to maintain bladder capacity and decrease residua1 urine in the follow-up of spinal cord injury patients. If the degree of VUR is mild at initial diagnosis, medical treatment must be performed with careful follow-up. If the degree of VUR is severe or gradually aggravated, we have to prevent renal deterioration and complications with early intensive treatment.