Endoscopic Subureteral Injection for Vesicoureteral Reflux in Adults With Neurogenic Bladder: Implications for Patients With Spinal Cord Injury – A Systematic Review
Leandro Blas, Ervin Amaya, Irma Ospina, Albert BorauABSTRACT
Introduction
Endoscopic subureteral injection (ESI) of bulking agents is an established treatment for vesicoureteral reflux (VUR) in pediatric populations; however, evidence in adults with neurogenic bladder remains limited. To systematically review the available evidence regarding the efficacy and safety of ESI for the treatment of VUR in adults with neurogenic bladder.
Methods
A systematic literature search was conducted in PubMed, Web of Science, and Cochrane Library up to December 2025, following PRISMA guidelines. Studies including adult patients with neurogenic bladder undergoing ESI for VUR were included. Data on patient characteristics, urodynamic findings, perioperative outcomes, and complications were extracted. Due to heterogeneity and limited sample size, a meta‐analysis was not performed.
Results
Six studies comprising 69 patients met the inclusion criteria. The mean age was 47.8 years, and spinal cord injury was the most common etiology. The pooled baseline VUR grade was 2.5. Cure rates after a single ESI ranged from 50% to 88.9%, with improvement rates reaching up to 94.4% when partial responses were included. Most patients requiring a second injection achieved complete resolution. Macroplastique was the most frequently used bulking agent. No major complications were reported, although reporting was limited. Follow‐up ranged from 12 to 28 months.
Conclusions
ESI with bulking agents appears to be a safe and potentially effective minimally invasive option for treating VUR in adults with neurogenic bladder. However, current evidence is limited by small sample sizes, heterogeneity, and lack of high‐quality comparative studies. Further prospective studies are needed to define optimal patient selection and treatment strategies.