Primary vesicoureteric reflux--our 20 years' experience

Area of Science:

• Pediatric Urology
• Surgical Procedures
• Vesicoureteral Reflux (VUR)

Background:

• Vesicoureteral reflux (VUR) is a common condition in children requiring surgical intervention.
• Antireflux surgery aims to prevent urine from flowing backward into the ureters and kidneys.
• Long-term clinical outcomes are crucial for determining the optimal surgical approach.

Purpose of the Study:

• To compare the long-term efficacy and outcomes of the Lich-Gregoir procedure and antireflux ureterocystoneostomy at the vertex of the bladder (AUVB).
• To evaluate the 20-year clinical experience with these two surgical techniques for pediatric VUR.
• To establish a preferred surgical strategy based on clinical evidence.

Main Methods:

• A retrospective analysis of 1648 antireflux ureterocystoneostomies performed between 1978 and 1998 in 1280 children.
• Comparison of AUVB (1032 units) and Lich-Gregoir procedure (616 units) outcomes.
• Evaluation of results, including success rates, failure rates, recurrence rates, and postoperative stenosis, 2 years post-operation.

Main Results:

• The Lich-Gregoir procedure demonstrated a higher overall success rate (96%) compared to AUVB (93.5%).
• Postoperative failure rates were lower for Lich-Gregoir (4%) than AUVB (6.5%).
• Recurrence rates favored Lich-Gregoir (1.5%) over AUVB (5%), though Lich-Gregoir had higher stenosis rates (2.5%).

Conclusions:

• The Lich-Gregoir procedure is recommended as the primary surgical option for pediatric VUR.
• AUVB is a viable alternative for managing recurrent VUR after initial Lich-Gregoir failure.
• Antireflux ureteroileocystoplasty is reserved for complex cases with repeated VUR or stenosis.