ABSTRACT

This chapter discusses the clinical conditions that contribute to upper tract deterioration, the pathophysiology of upper tract deterioration in patients with Neurogenic bladder (NGB) dysfunction, and the incidence of upper tract damage in common neurologic conditions that results in NGB dysfunction. It is likely that the high incidence of nephrolithiasis in some groups of patients with NGB dysfunction contributes to the higher risk of renal insufficiency compared to the general population. In this series, the incidence of renal dysfunction temporally tracks with development of vesicoureteral reflux (VUR). In healthy bladders, the valvular function of ureterovesical junction protects the low-pressure upper urinary tract from urine refluxing from the bladder. The increased risk is in part due to the lack of coordination between detrusor contractions and sphincter relaxation, a pathophysiology common to spinal conditions. These conditions include spinal cord injury, neural tube defects, and multiple sclerosis. Hydronephrosis, VUR, pyelonephritis, and renal insufficiency in patients with minimally treated NGB were commonplace, with incidence increasing with time from injury.