Injection therapy in those patients with neuropathic bladders has been shown to be effective. Perez-Brayfield et al describe a success rate of 78 % . Neuropathic bladder and injection therapy present a certain set of challenges. Neuropathic bladders often have severe trabeculation and fibrosis, and placement of the injectable material in the correct position and with adequate mound configuration
is often more technically challenging. In addition, due to high voiding pressures, neuropathic bladders are at increased risk for mound shifting. These patients should be maintained on a bladder-management regimen including anticholinergic medication and clean intermittent catheterization in order to keep bladder pressures low. 4
4. Perez-Brayfield M , Kirsch AJ , Hensle TW et al. Endoscopic treatment with dextranomer/hyaluronic acid for complex cases of vesicoureteral reflux. J Urol 2004 ; 172 : 1614 – 16 .