Antireflux in patients with neurogenic bladder

Area of Science:

• Urology
• Pediatric Urology
• Nephrology

Background:

• Neurogenic bladder often presents with high outflow resistance and severe trabeculation.
• These conditions have historically been considered contraindications for ureteral reimplantation.
• Successful management requires addressing these complex bladder dynamics.

Purpose of the Study:

• To evaluate the efficacy of ureteral reimplantation in neurogenic bladders with high outflow resistance and severe trabeculation.
• To identify critical factors for successful antireflux surgery in this patient population.

Main Methods:

• Retrospective analysis of 8 patients with neurogenic bladders undergoing ureteral reimplantation.
• Concurrent management of high outflow resistance, primarily with intermittent catheterization.
• Surgical technique emphasizing submucosal tunnel creation on the trigone.

Main Results:

• Ureteral reimplantation was technically successful in all 8 cases.
• Intermittent catheterization effectively managed high outflow resistance.
• The trigone proved to be a suitable site for submucosal tunnel creation, avoiding trabeculation.

Conclusions:

• High outflow resistance and severe trabeculation are not absolute contraindications for ureteral reimplantation in neurogenic bladders.
• Pre-operative or concurrent management of outflow resistance is crucial.
• Careful surgical technique, including trigonal tunnel creation, ensures successful outcomes.