| 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
(Affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo 113-8421, Japan.)
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| Journal | Journal of pediatric surgery
(J Pediatr Surg)
Vol. 42
Issue 12
Pg. 1998-2001
(Dec 2007)
ISSN: 1531-5037 United States |
| PMID | 18082695
(Publication Type: Journal Article)
|
| Topics |
- Adolescent
- Child
- Child, Preschool
- Cystoscopy
(methods)
- Female
- Follow-Up Studies
- Humans
- Male
- Reconstructive Surgical 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)
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