Endoscopic treatment of vesicoureteral reflux with macroplastique in spinal cord injury patients: A comparison of video-urodynamic parameters between treated and failed cases

Abstract

Context/Objective: Vesicoureteric reflux (VUR) is a well-known complication of neurogenic lower urinary tract dysfunction. VUR results to progressive renal deterioration and eventually renal failure. Our aim was to assess the efficacy of Macroplastique bulking agent in managing VUR in spinal cord injury population and correlate the pre- and postintervention VUDS (Video-urodynamics) findings with the outcome. Design: Retrospective cohort study. Participants: Spinal cord injury patients with VUR, treated with Macroplastique, had pre- and postintervention VUDS and followed up for at least 12 months. Interventions: Macroplastique injection and video-urodynamics. Outcome Measures: The primary endpoint was the overall treatment rate of VUR at 3 months. The secondary outcomes were the overall treatment rate of VUR at 12 months, the success rate at 3 and 12 months, the need for additional treatments, and the comparison of VUDS parameters in treated versus failed cases. Results: Forty-eight patients and 62 refluxing ureteric units were studied. At 3-month follow-up, the overall treatment rate was 79.1%. The overall success rate (treated + improved) was 90.3%. There is a statistically significant difference in baseline cystometric capacity (P = 0.047), degree of reflux (P < 0.01), and bladder compliance (P = 0.023) between the treated and failed cases. Conclusion: Macroplastique is effective in the management of VUR in spinal cord injury population. It is minimally invasive, quick, with low complication rates. Care should be taken to treat the parameters of the neurogenic bladder that contributes to secondary VUR development such as detrusor overactivity and poor bladder compliance.