EVALUATION OF VESICOURETERAL REFLUX IN NEUROGENIC BLADDER DYSFUNCTION AND CHOICE OF TREATMENT STRATEGY

Abstract

The aim of the research is to enhance the treatment outcomes of vesicoureteral reflux (VUR) that arises in the context of neurogenic bladder dysfunction (NBD) by developing a systematically justified approach for selecting treatment strategies for patients and improving existing treatment methods accordingly. Materials and Methods. A clinical examination was conducted on 279 patients with vesicoureteral reflux (VUR) that occurred in the context of neurogenic bladder dysfunction (NBD). Out of these, 87 patients received conservative treatment. The study design employed was a longitudinal (prospective) case-control study. Randomization was not used. Inclusion criteria required the presence of VUR in patients concurrently with NBD. Patients with Grade V VUR were excluded from the study. Clinical and laboratory manifestations of VUR and its complications were studied and assessed. A comprehensive evaluation of the severity of VUR and treatment effectiveness was performed. Patients were divided into three groups based on the proposed system "Method for a Comprehensive Assessment of the Severity of Vesicoureteral Reflux Disease and Treatment Effectiveness." Results. Vesicoureteral reflux (VUR) was most frequently observed in patients between the ages of 6 and 10, constituting 44.4% of the cases. VUR of Grade III-IV was more commonly diagnosed in patients under 5 years of age. Complaints related to urinary disorders tended to decrease or disappear with age (t= -0.1533; p=0.010). As patients grew older (after 7-8 years), the frequency of pyelonephritis exacerbations decreased (t= -0.1344; p=0.025). However, dilatation of the upper urinary tract (t=0.2157; p=0.001) and deterioration of kidney function (t=0.2354; p=0.001) were observed more frequently. Inflammation of the urinary tract occurred more frequently in women (t=0.1419; p=0.018), while renal function impairment due to VUR was more common in men (t= -0.1733; p=0.004). Conclusions. Most clinical and laboratory manifestations of vesicoureteral reflux (VUR) do not correlate with its grade. A reverse correlation was found between the grade of VUR and age, and a direct correlation with leukocyturia. Urinary disorders, leukocyturia, and the frequency of pyelonephritis exacerbations are components of VUR's clinical presentation that affect the quality of life and are among the first to change due to treatment, primarily through the normalization of bladder function. Clinical manifestations and complications of VUR negatively impact the quality of life in 66.2% of patients. The assessment of treatment effectiveness takes into account the grade of VUR and the complex of main clinical manifestations and complications, which can be considered using the proposed system "Method for a Comprehensive Assessment of the Severity of Vesicoureteral Reflux Disease and Treatment Effectiveness."

Keywords

• vesicoureteral reflux
• neurogenic bladder
• neurogenic bladder dysfunction