The effectiveness of ureteric reimplantation during bladder augmentation for high-grade vesicoureteric reflux in patients with neurogenic bladder: long-term outcome.

Abstract

PURPOSE:

The outcome of ureteric reimplantation (UR) during bladder augmentation (BA) for high-grade vesicoureteric reflux (HVUR) in patients with neurogenic bladder was assessed to determine the effectiveness of UR. A literature review of HVUR and BA was also performed.

METHODS:

Twenty-two consecutive sigmoidocolocystoplasty patients were reviewed retrospectively; 10 had unilateral HVUR only, 3 had bilateral HVUR, and 9 had unilateral HVUR associated with low-grade VUR in the contralateral renal unit (RU). Preoperatively, VUR was grade V in 3 RU, grade IV in 22 RU, grade III in 5 RU, and grade II in 4 RU. Ureteric reimplantation was performed in the native bladder in 24 RU (16 patients) and in the colon cap in 10 RU (6 patients).

RESULTS:

Mean age at sigmoidocolocystoplasty/UR was 8.5 years (range, 2-15 years). Mean follow-up was 12.8 years (range, 2-22 years). Postoperatively, cystourethrography showed residual VUR (grade IV to grade III) in only 1 RU (3%); diethylenetriamine pentaacetic acid scintigraphy showed no obstruction in all RU; (99m)Tc-dimercaptosuccinic acid was improved in 13 RU, unchanged in 18 RU, and worsened in 3 RU; and serum creatinine remained normal in 20 patients and worsened in 2. Urinary tract infection, universal preoperatively, was seen postoperatively in only 2 patients. In the literature, 0% to 16.7% of HVUR persisted after BA alone, and no long-term data were available.

CONCLUSIONS:

Ureteric reimplantation during BA is safe and effective for treating HVUR in patients with neurogenic bladder.

• Authors: Yutaka Hayashi, Yoshifumi Kato, Tadaharu Okazaki, Geoffrey J Lane, Hiroyuki Kobayashi, Atsuyuki Yamataka
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 42 Issue 12 Pg. 1998-2001 (Dec 2007) ISSN: 1531-5037 [Electronic] United States
• PMID: 18082695 (Publication Type: Journal Article)

Topics

• Adolescent
• Child
• Child, Preschool
• Cystoscopy (methods)
• Female
• Follow-Up Studies
• Humans
• Male
• Plastic Surgery Procedures (methods)
• Replantation (methods)
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Time Factors
• Treatment Outcome
• Ureter (surgery)
• Urinary Bladder (surgery)
• Urinary Bladder, Neurogenic (complications, diagnosis, surgery)
• Urinary Diversion (methods)
• Urodynamics
• Vesico-Ureteral Reflux (complications, diagnosis, surgery)