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Quo vadis? Ureteric reimplantation or ignoring reflux during augmentation cystoplasty
Yunus Soylet1, Haluk Emir, Zekeriya Ilce
1Division of Paediatric Urology, Department of Paediatric Surgery, Cerrahpasa Medical Faculty, University of Istanbul, D:23/3 (80220) Nisantasi, Istanbul, Turkey. ysoylet@superonline.com
Insights
Augmentation cystoplasty alone effectively resolves vesico-ureteric reflux (VUR) in children, even in complex cases. Combining it with antireflux surgery offers no significant additional benefit for VUR resolution or kidney function.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Bladder Reconstruction
Background:
- Vesico-ureteric reflux (VUR) often necessitates bladder augmentation in children with neurogenic bladder, infravesical obstruction, or exstrophy-epispadias.
- Augmentation cystoplasty aims to decrease intravesical pressure and increase bladder capacity, potentially resolving secondary VUR.
Purpose of the Study:
- To evaluate the necessity and efficacy of concurrent antireflux surgery during bladder augmentation in pediatric patients.
- To determine if adding antireflux procedures improves VUR resolution rates or preserves renal function compared to augmentation alone.
Main Methods:
- A retrospective study comparing 38 children undergoing bladder augmentation between 1987 and 2001.
- Group 1 (15 patients) received augmentation only; Group 2 (23 patients) had augmentation with concurrent antireflux surgery.
Main Results:
- VUR resolved in 97% of refluxing units after augmentation alone (Group 1) and 93% with combined surgery (Group 2).
- Bladder capacity significantly increased in both groups, from 35% to 86% (Group 1) and 38% to 90% (Group 2).
- No significant difference in VUR resolution or renal function was observed between the two groups.
Conclusions:
- Augmentation cystoplasty alone is recommended for managing VUR in children with neurogenic bladder, infravesical obstruction, and exstrophy-epispadias.
- Concurrent antireflux surgery does not offer significant advantages in VUR resolution or renal function preservation when combined with augmentation cystoplasty.
Objective:
To decide whether antireflux surgery should be used in the presence of vesico-ureteric reflux (VUR) in children, in whom an augmentation procedure is needed, because secondary VUR in children with a neurogenic bladder, infravesical obstruction and primary VUR in the exstrophy-epispadias complex is expected to resolve after augmentation, which decreases the intravesical pressure and increases capacity.
Patients And Methods:
Between 1987 and 2001, the bladder was augmented in 38 children, using no antireflux surgery in group 1 (15 patients) and antireflux surgery in group 2 (23 patients).
Results:
VUR was detected in all patients on cysto-urethrography before surgery; reflux resolved after augmentation cystoplasty in 97% and 93% of refluxing units in groups 1 and 2, respectively. The increase in the expected bladder capacity was from 35% to 86% in group 1 and from 38% to 90% in group 2. No patient had any deterioration in renal function.
Conclusions:
We recommend using only augmentation in patients with low- or high-grade VUR and a neurogenic bladder, infravesical obstruction and exstrophy-epispadias. Combining antireflux surgery with cystoplasty has no significant effect on either the resolution of VUR or renal function.
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