The natural history of vesicoureteric reflux in children with neuropathic bladder and open neural tube defects.

Vesicoureteric reflux in children with neuropathic bladder and open neural tube defects has been reviewed to determine its natural history. In 78%, reflux was identified during the first 2 years, emphasising the importance of investigation in the neonatal period and at regular intervals thereafter. Deterioration occurred in 67%. Those most likely to deteriorate had a flaccid detrusor and bilateral reflux, which was grade 4 or greater at the time of diagnosis. Only 24% remained unchanged and in only 9% did reflux resolve spontaneously. Many patients were treated by continuous or intermittent catheterisation, or by surgical procedures to reduce outflow obstruction, but with disappointing results. Surgical intervention for deteriorating upper tracts was usually late and involved extensive procedures such as nephroureterectomy or urinary diversion. The results suggest that treatment should be aimed primarily at restoration of the anti-reflux function of the vesicoureteric junction. Using endoscopic subureteric Teflon injection (STING) at an early stage, especially in the at risk group, it should be possible to avoid ongoing renal damage and more extensive, salvage surgery at a later date.