Treatment of vesicoureteral reflux in patients with neurogenic bladder. Should the ureter be reimplanted in patients treated with augmentation cystoplasty

OBJECTIVES: To evaluate the necessity of performing ureteral reimplantation in patients with vesicoureteral reflux secondary to neurogenic bladder. METHODS: Retrospective review of 19 patients (10 males and 9 females), between 2 and 19 years of age (Mean age 7 years), with neurogenic bladder and vesicoureteral reflux (VUR) treated from May 1990 to July 2000. No one patient had a satisfactory response to the therapy with anticholinergic drugs and clean intermittent catheterization. All 19 patients underwent augmentation cystoplasty (15 using sigmoid colon and 4 ureter). Ten patients, 16 renal units, underwent simultaneous ureteral reimplantation. RESULTS: All patients improved their bladder capacity and compliance after bladder augmentation. VUR disappeared in 17 patients. Two patients (3 renal units) in the group without ureteral reimplantation remained with a minor degree of reflux. CONCLUSIONS: Bladder augmentation alone resolves VUR secondary to neurogenic bladder in a high percentage of patients.