title: Prognostic factors of endoscopic treatment of vesicoureteral reflux in spinal cord injured patients.
abstract: BACKGROUND
  Vesicoureteral reflux (VUR) is an important complication in patients with spinal cord injury due to its frequency and morbidity. One of the most extended therapeutic options is endoscopic injection of obliteration substances in the urethral meatus.
  
  
  OBJECTIVE
  To analyze the prognostic factors of VUR treatment using obliterative substances in patients with spinal cord injury.
  
  
  METHODS
  A prospective study was performed in a cohort of 76 patients (age 48.9±14.4 years), of both genders, with spinal cord injuries, who underwent endoscopic treatment of the VUR during the years 2008 to 2011. In all the patients, a clinical history was obtained and a pre-operative videourodynamic study was performed. Another study was carried out at 7.32 months (standard deviation: 6.28 months) of the intervention. Treatment consisted in endoscopic injection of dextranomer/hyaluronic acid copolymer (62 cases) and polydimethylsiloxane (14). The statistical tests applied were the Fisher's exact test and the Student's T test comparing the means. Bilateral significance level was established at 95%.
  
  
  RESULTS
  Resolution of VUR was achieved in 46 cases (61%). The statistically significant prognostic factors were age (younger aging cured patients), bilaterality and reflects great (greater grade in bilaterality in the cases with persistence of reflux) and presence of neurogenic detrusor overactivity (greater percentage in the cases of reflux persistence). Stress urinary incontinence (greater percentage in cured patients), contractile potency (lower percentage in cured patients) and urethral resistance (greater percentage in cured patients) were also statistically significant prognostic factors.
  
  
  CONCLUSIONS
  Among the prognostic factors that affected the endoscopic treatment results of the VUR in patients with neurogenic lower urinary tract dysfunction (NLUTD), anatomical as well as functional factors were found.
authors.affiliation: Servicio de Urología, Hospital Nacional de Parapléjicos, Toledo, España. Electronic address: santiago.mendez@telefonica.net.
authors.forename: M
authors.initials: M
authors.lastname: Vírseda
authors.forename: J
authors.initials: J
authors.lastname: Salinas
authors.forename: E
authors.initials: E
authors.lastname: Bolufer
authors.forename: M
authors.initials: M
authors.lastname: Esteban
authors.forename: S
authors.initials: S
authors.lastname: Méndez
mesh_terms: D003558:Cystoscopy; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000150:complications; D014718:Vesico-Ureteral Reflux / Q000209:etiology / Q000628:therapy*
keywords: Endoscopic treatment; Lesión medular; Reflujo vesicoureteral; Spinal cord injury; Tratamiento endoscópico; Vesicoureteral reflux; Videourodinámica; Videourodynamics