[Endoscopic treatment of vesico-ureteral reflux in the neurogenic bladder. Presentation of 2 cases and review of the literature]. / Tratamiento endoscópico del reflujo vésico-ureteral en la vejiga neurogénica. Presentación de dos casos y revisión bibliográfica.

OBJECTIVE: To describe two cases of vesicoureteric reflux associated with neurogenic bladder treated by endoscopic subureteric injection of collagen. METHOD: A 22 Fr cystoscope was introduced with the patient in the lithotomy position. The meatus was identified, a 6 Fr needle was introduced beneath the meatus and collagen was injected until the terminal ureter had been raised with the meatus at the top. RESULTS: One year later the first patient consulted for recurrent urosepsis and severe incontinence between catheterizations. Patient assessment disclosed multiple bladder lithiasis and bilateral vesicoureteric reflux grade III-IV. Endoscopic electrohydraulic lithotripsy was performed, the urine sterilized and collagen injected under the ureter on both sides without result. The procedure was repeated later and reflux disappeared completely. The control ultrasound was satisfactory, urosepsis was controlled and incontinence had improved. Recovery of the upper urinary tract was observed six months later. The second patient consulted one year later for frequent urosepsis, urge incontinence and increasing residual urine. Patient evaluation disclosed vesicoureteric reflux grade III on the right side and signs suggestive of external sphincter hypertony, external sphincter disease and bladder trabeculation. Subureteric injection of collagen combined with endoscopic external sphincterotomy reduced the reflux from grade III to grade I. Collagen injection was repeated and reflux disappeared. The control ultrasound was satisfactory, urine sterile and urinary continence was acceptable. Recovery of the upper urinary tract was observed six months later. CONCLUSION: Subureteric injection of collagen was effective in both cases. It permitted precise evaluation of bladder function and did not interfere with bladder reeducation. Bladder emptying and urinary continence improved, urinary infection was better controlled and it facilitated upper urinary tract recovery. The procedure is fast and can be performed on an outpatient basis. It is safe, repeatable and does not interfere with subsequent therapeutic modalities. No differences between teflon and collagen have been found in the literature.