Treatment of vesicoureteric reflux in the neurogenic bladder

A retrospective co-operative study was conducted among 6 Italian paediatric surgical departments to assess the results of different forms of treatment of vesicoureteric reflux in patients with neurogenic bladder. Between January 1980 and December 1989 we studied 641 neurogenic bladders in children, mainly due to spina bifida; reflux was detected in 199 patients with 263 refluxing ureters. Details of treatment were available for only 170 patients and they were divided into 2 main groups: conservative medical treatment (n = 127) and primary surgical treatment (n = 43). Medical treatment consisted mainly of clean intermittent catheterisation and the administration of appropriate drugs. In the surgical group 36 reimplantations, 6 cystostomies and 1 STING were performed. Fifteen patients underwent surgery as a secondary procedure. The results showed that approximately 50% of patients with reflux were cured by clean intermittent catheterisation and drug therapy. Ureteric reimplantation can be safely performed in patients with neurogenic bladder provided that a normally compliant, non-hyper-reflexic bladder can be achieved by means of drugs or by bladder augmentation with bowel.