Reoperative ureteroneocystostomy: review of 69 patients

Reoperative ureteroneocystostomy in 69 patients with primary vesicoureteral reflux was reviewed. Of the renal units 49 were obstructed and 48 had reflux. Postoperative obstruction was caused by mechanical factors in 61 per cent of the renal units, distal ureteral scarring in 31 per cent and a previously unrecognized functionally neurogenic bladder (without a neurological lesion) in 8 per cent. Persistent postoperative reflux was secondary to a short submucosal tunnel in 94 per cent of the renal units and occult neurogenic bladder in 6 per cent. Reoperative ureteroneocystostomy was successful in 79 per cent of the renal units, with a mean followup of 33 months. The modified Paquin technique (omitting the ureteral cuff) yielded consistently superior results in children undergoing reoperation for ureterovesical junction obstruction. In patients with postoperative vesicoureteral reflux a variety of techniques produced similar and gratifying results. That 52 per cent of our patients had no symptoms indicates clearly the absolute necessity of careful followup after ureteral reimplantation. Furthermore, 20 per cent of our patients had late failure (4 to 10 years after initial ureteroneocystostomy), which suggests the need for careful monitoring of the reimplanted ureter past puberty.