Long-term Follow-up of Spinal Cord Injured Patients with Vesicoureteral Reflux

Authors

  • Suksathien R Department of Rehabilitation Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand

Keywords:

spinal cord injuries, vesico-ureteral reflux, hydronephrosis, urodynamics, long-term outcome

Abstract

Objectives: to investigate the management of VUR, outcomes after treatment and factors associated with VUR outcomes in SCI patients.

Study design: Retrospective data collection

Setting: Maharat Nakhon Ratchasima Hospital

Subjects: Spinal cord injured patients admitted to the Rehabilitation ward between August 2008 and July 2019.

Methods: The medical records of 59 spinal cord injured (SCI) patients with 81 vesicoureteral reflexes (VUR) admitted to our hospital between August 2008 and July 2019 with minimum one-year follow-up were reviewed retrospectively.  General demo- graphics, urological information, including bladder management, medications, urodynamic studies, eGFR, UTI, calculi and imaging, including hydronephrosis, bladder deformity and VUR grading, were investigated. Grading of VUR during follow-up were compared to the initial assessment and classified into good (transient or improved) vs poor (stable or progress) outcomes. Bivariate analysis was performed to examine an association between  urological variables and good or poor outcomes.

Results: The majority of VUR (83%) developed within 4 years after SCI. Before VUR was detected, only 23.7% of the patients received antimuscarinic medication and the most common  bladder management was indwelling catheterization (69.5%).   Management post-VUR included indwelling catheterization (83.1%), antimuscarinics (98.3%) and antibiotics (72.7%).  VUR outcomes were noted to be transient in 23.7%, improved in 30.5%, stable  in 18.6%, and  progressive in 27.1%.  One patient had eGFR that revealed CKD stage 5 which needed hemodialysis.  Three patients had impaired renal function assessed by renal scan.  Follow-up VUR was categorized into 2 groups (good vs poor outcomes). Patients with low bladder compliance showed a significant association with poor outcome.  High detrusor pressure (Pdet > 40 cmH2O) tended to have poor outcome but did not reach statistical significance. Indwelling catheterization and antibiotic prophylaxis for management of VUR did not show a significant difference in outcomes.

Conclusion: VUR remains an important complication in SCIpatients, leading to upper urinary tract deterioration. About half of VUR patients improved after conservative treatment. Bladder  compliance was a factor associated with VUR outcome. Indwelling catheterization or antibiotic prophylaxis did not prevent  progression of VUR.  Early urological management and regular urological evaluation should be performed in SCI patients.

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Published

2020-04-28

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Original Article