Vesicoureteral reflux in complete ureteral duplication: surgical options

Vesicoureteral reflux is the most common abnormality seen with complete ureteral duplication. The majority of cases require surgical correction. The techniques used in 62 patients with 71 duplicated systems with reflux are reviewed. Reflux into the lower pole was encountered in 51 duplicated systems, both poles in 19 systems and the upper pole in 1. A total of 42 conjoint ureteral reimplantations was performed but in 8 cases only the lower pole ureter with reflux was reimplanted after it was separated from the nonrefluxing ureter. Ipsilateral ureteroureterostomy was performed in 19 cases of lower pole reflux. Two patients underwent lower pole heminephrectomy. Satisfactory results were obtained by all 3 reconstructive techniques. However, for lower pole reflux we recommend ipsilateral ureteroureterostomy unless a contralateral operation also is necessary. Ureteroureterostomy proved to be a simple and safe operation free of complications, with little morbidity and requiring a shorter hospitalization.