VESICOURETERAL REFLUX IN ADULT PATIENTS WITH SPINAL-INJURY

Objectives To review the incidence, aetiology, treatment and prognosis of vesico-ureteric reflux (VUR) in patients in a regional spinal inju ries centre. Patients and methods A retrospective review of radiologic al cal investigations revealed 34 of 447 (8%) patients with VUR on at least one study, The notes of these patients were examined to determin e their management and outcome. Results Most patients developed VUR wi thin 4 years of injury; the underlying intravesical pressure was high in half the patients studied. Patients were managed aggressively with a variety of medical and surgical techniques. The VUR of 15 patients r esolved completely and in three patients there was some improvement. R enal function deteriorated in three patients as assessed by isotopic s canning. Two patients were transferred to our unit in end-stage renal failure associated with VUR and died within one year. Conclusions VUR continues to be a problem in patients with spinal injury and remains p otentially fatal through the effects of high transmitted pressure and infection. Renal failure does not always develop as a consequence of t he combination of VUR and high intravesical pressure. No single aetiol ogical factor for VUR was found. With active early treatment, the inci dence of VUR can be minimized and long-term complications avoided.