Anti-reflux surgery in the congenital neuropathic bladder

42 refluxing ureters were re-implanted into the bladder in 28 children with neuropathy. In each case other measures directed at enhancing bladder emptying were employed. Reflux was cured in 36 of 38 ureters investigated after operation. The incidence of contralateral reflux following unilateral re-implantation was 50%. 1 of 12 undilated units showed late post-operative deterioration. 22 of 28 initially hydroureteronephrotic units either improved or stabilised at a satisfactory level. In 6 children urinary diversion was subsequently performed because of persistent reflux (2 cases), postoperative deterioration (1 case) or failure of severely dilated upper tracts to improve (3 cases). Since reflux from a high pressure bladder can rapidly cause severe renal damage, cystography is indicated when there is clinical or pyelographic suspicion of its existence. Operative cure is needed when reflux is of major degree or if, when of lesser severity, it does not stop spontaneously following improved bladder emptying resulting from therapeutic lessening of the urethral resistance.