The role of abnormal congenitally displaced ureteral orifices in causing reflux following spinal cord injury.
OBJECTIVE
To determine the role of congenitally displaced ureteral orifices in causing vesicoureteral reflux (VUR) in individuals with spinal cord injury (SCI).


METHODS
Retrospective chart review.


METHODS
Men and women with (UMN) neurogenic bladders secondary to SCI.


METHODS
Position of the ureteral orifice and urodynamic parameters in association with VUR.


METHODS
A retrospective chart review was performed to identify SCI participants with and without reflux who had evaluation with cystoscopy, cystogram, and urodynamics. The position of ureteral orifice was compared in individuals with SCI who did and did not have ureteral reflex. All cystogram studies were interpreted by board-certified radiologists. The International Classification system was used to grade the severity of the reflux. Fisher exact test was used to evaluate the association of the posterior ureteral orifice and reflux. Analysis also was performed to evaluate the association of reflux with posterior-placed ureteral orifices and urodynamic parameters in the reflux group and nonreflux group.


RESULTS
Fifteen participants were found to have reflux--11 had posterior-placed ureteral orifices, whereas 4 had normally positioned orifices. The 11 individuals with posterior-placed ureteral orifices had no bladder wall trabeculation. However, all 4 individuals with normally positioned ureteral orifices had severe trabeculation. Seventeen participants did not exhibit reflux--2 had posteriorly placed ureteral orifices and 15 had normally positioned orifices. Association of posterior position and reflux (P = 0.004). No differences were found with regard to bladder capacity, bladder wall compliance, or voiding pressures between the reflux group and nonreflux group.


CONCLUSIONS
Congenitally displaced ureteral orifices are an important cause of VUR in individuals with SCI. Participants with normally positioned ureteral orifices only had reflux in the presence of severe trabeculation. This study suggests that annual screening with cystograms may not be necessary in individuals with normally positioned ureteral orifices and no significant trabeculation.
Linsenmeyer
Todd A
TA
Department of Urology, Kessler Institute for Rehabilitation, West Orange, New Jersey 07053, USA. tlinsenmeyer@kessler-rehab.com
House
J Glen
JG
Millis
Scott R
SR
D003558:Cystoscopy; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D014513:Ureter / Q000002:abnormalities*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology