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Politano-leadbetter ureteroneocystostomy. A 30-year experience
J Steffens1, P H Langen, B Haben
1Department of Urology and Pediatric Urology, St. Antonius-Hospital, Eschweiler, Germany.
Insights
The Politano-Leadbetter ureteroneocystostomy is a safe and effective surgical treatment for pediatric vesicoureteral reflux, achieving a 93.6% success rate. However, it may be linked to the late development of hypertension.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Renal Health
Background:
- Vesicoureteral reflux (VUR) in children can lead to renal scarring and hypertension.
- The Politano-Leadbetter ureteroneocystostomy is a surgical technique used to correct VUR.
- Long-term outcomes, including renal parenchymal scarring and hypertension, require evaluation.
Purpose of the Study:
- To assess the efficacy and complications of the Politano-Leadbetter ureteroneocystostomy in pediatric patients.
- To evaluate changes in renal parenchymal scarring before and after surgery.
- To determine the incidence of late-onset hypertension following the procedure.
Main Methods:
- A retrospective review of 666 children (814 renal units) undergoing Politano-Leadbetter ureteroneocystostomy between 1965 and 1996.
- Average follow-up of 10.3 years, with 68.8% of patients evaluated at 10 years post-surgery.
- Analysis of pre- and postoperative renal scarring and development of hypertension.
Main Results:
- The Politano-Leadbetter ureteroneocystostomy demonstrated a 93.6% success rate in treating VUR.
- Postoperative complications occurred in 7.8%, with persistent reflux being the most common (5.6%).
- Renal scarring increased from 21.2% preoperatively to 27.7% postoperatively; 8.7% developed hypertension, often managed by nephrectomy.
Conclusions:
- The Politano-Leadbetter ureteroneocystostomy is a safe and successful surgical option for pediatric VUR.
- Despite successful reflux correction, a subset of patients may develop late-onset hypertension.
- Monitoring for hypertension is crucial in children treated with this procedure.
Purpose:
We evaluated the results and complications of children with reflux treated with the Politano-Leadbetter ureteroneocystostomy. In particular, we evaluated pre- and postoperative renal parenchymal scarring and the late development of hypertension.
Materials And Methods:
From 1965 through 1996, 666 children (814 renal units) were reimplanted by nine urologists. The average postoperative evaluation was 10.3 years, and 68.8% of all patiens were evaluable 10 years after surgery.
Results:
Postoperative complications occurred in 7.8% and consisted of small bowel serosal injury (0.3%), vesicocutaneous fistula (0.4%) and retrovesical hematoma (0.3%). Persistent reflux was the most common postoperative complication (5.6%) and was found to occur in higher grades of vesicorenal reflux. Ureteral stricture and hydronephrosis were seen in 1.2% of children, and was corrected with a secondary reimplantation. Late stricture occurred in all but 1 patient (0.2%). Renal parenchymal scarring was found in 21.2% of patients preoperatively, and this increased over time postoperatively to 27.7%. In 8.7% of these patients, hypertension developed between the 6th and 17th postoperative year. In 6.1%, nephrectomy was carried out, which normalized blood pressures in 87. 9% of these 30 patients.
Conclusions:
The Politano-Leadbetter ureteroneocystostomy was successful in 93.6% of all 814 renal units surgically treated. The operation is safe, but can be associated with late development of hypertension despite correction of the reflux.
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