Neurogenic bladder and secondary vesico-ureteral reflux

A 13-month-old female presented with recurrence febrile UTI since 8 months ago.

several hospital admission and IV antibiotic were needed despite continoues profilactic antibiotics. 

Ultrasound study revealed single left kidney with mild hydronephrosis and decreased parenchymal thickness.

voiding cysto-urethro graphy (VCUG)

Renal DMSA scan

Urodynamic study

treatment

Oral anticholinergic and 2 times intravesical botulinum toxin A injection (first at the time of diagnosis and second 5 years later) and limited profilactic antibiotic.

DRNC scan after  4 months of diagnosis and treatment

Renal DMSA scan after  6 months of diagnosis and treatment

During 8 years follow up, urine cultures were mostly negative. Two events of asymptomatic lower UTI during the first post-intervention which was successfully treated.

Urodynamic after 5 years

DMSA scan after 7 years

DRNC scan after 8 years

Farzaneh Sharifiaghdas, professor of urology

Labbafinejad Medical Center, The Center of Excellence in Urology