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The management of vesicoureteral reflux in children with neurogenic bladders
Insights
Clean intermittent catheterization safely manages pediatric neurogenic bladder with reflux. Low-grade reflux may resolve, while ureteroneocystostomy effectively treats recurrent infections and prevents renal damage.
Area of Science:
- Pediatric Urology
- Nephrology
- Pediatric Surgery
Background:
- Neurogenic bladder dysfunction and vesicoureteral reflux (VUR) are common in children.
- Management aims to prevent upper urinary tract deterioration and infection.
- Clean intermittent catheterization (CIC) is a cornerstone of neurogenic bladder management.
Purpose of the Study:
- To evaluate the safety and efficacy of CIC in managing pediatric VUR.
- To assess the outcomes of nonoperative management versus surgical intervention for VUR in neurogenic bladders.
- To determine the role of ureteroneocystostomy in managing refractory VUR.
Main Methods:
- Retrospective review of 62 children with neurogenic bladder and VUR.
- Initial management with CIC, low-dose antimicrobials, and nonoperative follow-up.
- Surgical intervention (antireflux surgery or urinary diversion) for febrile UTIs or upper tract deterioration.
Main Results:
- 57/90 kidneys showed hydronephrosis or scarring; 33 were normal.
- Low to moderate VUR resolved spontaneously in some cases managed with CIC.
- Ureteroneocystostomy was effective for recurrent infections when bladder dysfunction was controlled.
- Higher-grade reflux often persisted, associated with pyelonephritis and renal damage.
Conclusions:
- CIC is a safe initial management for pediatric VUR with neurogenic bladder.
- Spontaneous resolution of low/moderate VUR is possible with CIC.
- Ureteroneocystostomy is a reliable treatment for recurrent infections in neurogenic bladder disease.
- Early ureteroneocystostomy is favored for high-grade reflux due to associated renal damage.
Abstract:
Sixty-two children with 90 refluxing ureters and neurogenic bladder dysfunction were initially managed by clean intermittent catheterisation. The upper urinary systems demonstrated hydronephrosis and/or parenchymal scarring in 57 kidneys and were normal in 33. Each child was placed on low dose antimicrobials and followed nonoperatively unless there was evidence of a febrile urinary tract infection or upper tract deterioration at which point antireflux surgery or urinary diversion was performed. Our experience suggests that children with neurogenic bladders and reflux may be safely managed by clean intermittent catheterisation and that low or moderate degrees of reflux may actually disappear. If recurrent bacilliuria or febrile urinary infections are noted then ureteroneocystostomy is a reliable and effective treatment option in neurogenic bladder disease provided that the bladder dysfunction is controlled. Higher grades of reflux have proven more difficult to manage and in our experience the reflux has not spontaneously abated and frequently there are associated episodes of acute pyelonephritis and renal damage. Because of our success with reimplantation surgery, we now favour early ureteroneocystostomy in such circumstances. With effective management of the neurogenic bladder dysfunction with intermittent catheterisation permanent urinary diversion should only occasionally be necessary because of vesicoureteral reflux.