Vesicoureteral reflux and lower urinary tract injury: The possible role of suprapubic cystostomy

Incidental vesicoureteral reflux was noted frequently during routine cystographic evaluation of patients who suffered vesicourethral trauma and who were managed by suprapubic cystostomy. Based on this observation we designed a retrospective study to document the prevalence of vesicoureteral reflux among 30 consecutive patients following vesicourethral trauma. In 9 patients drainage was instituted by urethral catheter and in 21 by suprapubic cystostomy. Of the latter 21 patients 10 (47.6%) had evidence of vesicoureteral reflux on cystography, which was associated with complete rupture of the urethra in 9 (90%). No patient who was treated initially with a urethral catheter had evidence of vesicoureteral reflux on cystography. We conclude that the prevalence of vesicoureteral reflux is significantly affected by the coexistence of severe vesicourethral injury and the presence of suprapubic cystostomy. The significance of this observation is in the potential risk of ascending upper urinary tract infections due to the hazardous combination of vesicoureteral reflux and frequent recurrent lower urinary tract infections. Presence of vesicoureteral reflux in these patients may necessitate a prophylactic antibiotic regimen. The specific mechanisms that lead to increased prevalence of vesicoureteral reflux in patients following severe vesicourethral injury are not defined by our results. However, we propose a multifactorial concept that may explain our observation.