Bladder outlet resistance decreasing operations in spinal cord damaged patients with vesicoureteral reflux.

Bladder outlet resistance decreasing operations were carried out on 68 spinal cord damaged patients with 87 vesicoureteral refluxes in the Paraplegic Centre, Hamburg, from 1982 to 1988. These patients were studied regularly with infusion urography and voiding cystourethrograms combined with urodynamic procedure. Although the primary aim of the operative treatment was to achieve balanced voiding, 62 (71%) refluxes disappeared, 10 (12%) changed for the better, 13 (15%) stood unchanged and 2 (2%) worsened. It was observed that the results of operative treatment of secondary vesicoureteral reflux depend only on the recuperative capacity of ureterovesical junction after reducing the pathologically increased bladder outlet resistance. Successful treatment of secondary vesicoureteral reflux does not influence renal parenchymal scarring. In all of the patients with unchanged or worsened reflux balanced voiding has still not been achieved, the bladder outlet resistance being not sufficiently decreased.