Surgical treatment of reflux in neurologically impaired child

Ninety-three consecutive patients with neurologically impaired bladders were evaluated for vesicoureteral reflux. Of 22 patients found to have reflux, 3 had spontaneous remission of reflux, 8 were maintained on suppressive antibiotic therapy, and 11 required ureteral reimplantation. A total of 14 refluxing renal units underwent ureteroneocystostomies. Twelve of 14 have had no postoperative reflux. The remaining two renal units are now free of reflux following augmentation cystoplasty. The modified Hutch ureteroneocystostomy is particularly suited for use in patients with neuropathic bladders, in that no submucosal tunnel is necessary. The operative technique is described.