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Ureteric re-implantation in the neuropathic bladder
R J Brereton1, R Narayanan, C Ratnatunga
1Department of Surgery, Hospitals for Sick Children, London, UK.
The British Journal of Surgery
|December 1, 1987
Summary
Ureteroneocystostomy is an effective treatment for neuropathic bladder in children, significantly improving outcomes for most patients. This surgical approach minimizes the need for urinary diversion in pediatric cases.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Background:
- Neuropathic bladder affects numerous children, often leading to complications like vesico-ureteric reflux.
- Urinary diversion was historically a common intervention for severe cases.
Purpose of the Study:
- To evaluate the efficacy of ureteroneocystostomy in managing pediatric neuropathic bladder.
- To assess the outcomes and necessity of urinary diversion in this patient group.
Main Methods:
- Retrospective study of 174 children with neuropathic bladder over 5 years.
- Analysis of 31 ureteroneocystostomy procedures in 17 patients with significant vesico-ureteric reflux.
- Documentation of surgical outcomes, including revisionary procedures and pyeloplasty.
Main Results:
- Only 7 out of 174 children required urinary diversion.
- 13 out of 17 patients (76%) undergoing ureteroneocystostomy showed significant improvement.
- Two patients experienced deterioration post-ureteroneocystostomy; four required revisionary surgery.
Conclusions:
- Ureteroneocystostomy is a highly effective surgical option for pediatric neuropathic bladder, particularly in cases with reflux.
- This procedure significantly reduces the need for more invasive urinary diversion techniques.
- Careful patient selection and surgical technique are crucial for optimal outcomes.