Ureteric re-implantation in the neuropathic bladder

Abstract

During the last 5 years 174 children with neuropathic bladder were studied, and only 7 required urinary diversions. A total of 31 ureteroneocystostomies were performed in 17 patients, 16 of whom had gross vesico-ureteric reflux. Revisionary surgery was required in four children and two underwent pyeloplasty. Deterioration followed ureteroneocystostomy in two patients, but 13 (76 per cent) of the children were significantly improved.

Vesico-ureteric reflux in adults with neuropathic bladders treated with Polydimethylsiloxane (Macroplastique®)

“…3,4 Furthermore open surgical procedures further stress already distressed patients with spinal injury. Endoscopic injection of Macroplastique 1 is simple, eective and without complications, and can be performed as a day case procedure.…”

“…Furthermore, these procedures are more dicult in thick walled trabeculated neuropathic bladders often with less rewarding results as compared to correction of primary VUR. 3,4 Correction of VUR by endoscopic injection of Te¯on paste was ®rst described by Matovschek in 1981. 5 Since then, numerous investigators have reported encouraging results of endoscopic correction of both primary and secondary VUR mostly in children.…”

Ureteroneocystostomy in the Neuropathic Bladder Associated with High-Grade Reflux

“…Vesicoureteral reflux in the neuropathic bladder is thought to be related to chronic infection, sacculation of the bladder wall near the ureteral orifices and to detrusor sphincter dyssynergia [1,2,[14][15][16]. Vesicoureteral re flux, parenchymal scarring, hydronephrosis and pyelone phritis are usually not present at birth in children with congenital neuropathic bladders; these complications may develop as a consequence of abnormal voiding mechanisms which allow bladder overdistention, high intravesical pressure, incomplete bladder emptying and urinary tract infections to occur [17].…”

“…Belloli et al [27] had good results in 27 reimplanted ureters in 16 children and stated that reimplantation should be preferred to permanent urinary diversion even if there is gross reflux. Brereton et al [1] reported a 76% improvement of gross vesicoureteral reflux. They had performed ureteroneo cystostomies in 17 patients, and only in 4 children revi sionary surgery was required (table 1).…”

“…This nephropathy is very often secondary to vesicoureteral reflux (VUR), existing in 15-50% of patients with a neuropathic blad der [1], VUR can be managed by treating all predisposing fac tors such as urinary tract infection, high-grade intravesi cal pressure and obstruction. However, in 20-25% of children with neuropathic bladder accompanied by re flux, progressive deterioration of the upper urinary tract requires surgical treatment [2].…”