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Related Experiment Videos

Is primary obstructive megaureter repair at risk for contralateral reflux?

P Caione1, N Capozza, L Asili

  • 1Division of Pediatric Urology, Department of Surgery, "Bambino Gesù" Children's Hospital, Research Institute, Rome, Italy.

The Journal of Urology
|August 25, 2000
PubMed
Summary

Contralateral reflux is common after unilateral ureteral reimplantation for vesicoureteral reflux but rare after repair for obstructive megaureter. Differentiating surgical approaches is crucial for managing these conditions.

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Area of Science:

  • Pediatric Urology
  • Nephrology
  • Surgical Innovation

Background:

  • Contralateral vesicoureteral reflux (VUR) is a known complication following unilateral VUR repair.
  • The risk factors and incidence of contralateral VUR after unilateral ureteral reimplantation for congenital obstructive megaureter (COM) are not well-established.

Purpose of the Study:

  • To compare the risk of developing contralateral reflux after unilateral ureteral reimplantation in children with COM versus primary VUR.
  • To investigate the correlation between surgical approach and the onset of contralateral reflux.

Main Methods:

  • A comparative study involving 58 children with unilateral COM and 98 children with unilateral VUR.
  • Surgical techniques included cross-trigonal ureteroneocystostomy and longitudinal ureteral reimplantation, with or without tapering (Hendren, Kalicinski).

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  • Postoperative monitoring included serial renal ultrasound, diethylenetetraminepentaacetic acid (DTPA) nuclear scan, excretory urogram, and voiding cystourethrogram (VCUG).

    • Main Results:

    • New-onset contralateral reflux occurred in 1.7% of the COM group versus 11.2% in the VUR group (p = 0.033).
    • The incidence of contralateral reflux in the COM group was not correlated with age, sex, or surgical technique.
    • The incidence of contralateral reflux in the VUR group was also not correlated with age, sex, or surgical technique.

    Conclusions:

    • Ureteral reimplantation for unilateral COM does not appear to increase the risk of contralateral reflux.
    • The high incidence of contralateral reflux after unilateral VUR repair suggests potential underlying trigonal dysfunction.
    • Surgical management strategies for unilateral VUR and unilateral COM should be distinct, considering the differing risks of contralateral reflux.