Related Experiment Video
Updated: May 22, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Long-term follow-up after ureteral reimplantation in children: a 12-year analysis
T Gerwinn1,2, M Zellner3,4, A Prouza5,3
1Division of Pediatric Urology, University Children's Hospital Zurich, Zurich, Switzerland. tim.gerwinn@kispi.uzh.ch.
Insights
Children with uneventful recoveries after ureteral reimplantation (UR) for high-grade vesicoureteral reflux (VUR) have a low risk of late complications. Routine long-term follow-up may not be necessary for all patients.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- High-grade vesicoureteral reflux (VUR) and primary obstructed megaureter (POM) in children often require ureteral reimplantation (UR).
- Long-term outcomes and the necessity of routine follow-up after UR are not fully established.
Purpose of the Study:
- To evaluate late surgical complications and long-term kidney outcomes after UR for high-grade VUR and POM.
- To assess the need for routine long-term follow-up in pediatric patients undergoing UR.
Main Methods:
- Retrospective review of 135 children undergoing UR (2006-2013) with at least 10 years of follow-up.
- Primary outcomes: postoperative ureterovesical junction obstruction (pUVJO) and febrile urinary tract infections (UTIs).
- Secondary outcomes: kidney function (BUN/creatinine), renal morphology, and hypertension.
Main Results:
- 53 renal units in 34 children met criteria. pUVJO occurred in 7.5% (exclusively after Politano-Leadbetter technique, within 8 months).
- Febrile UTIs occurred in 9 children, mostly within the first postoperative year.
- One child developed chronic kidney disease; another developed reflux nephropathy without impaired function. No hypertension observed.
Conclusions:
- Children with uneventful recoveries and no pUVJO in the first year have a low risk of late complications.
- Routine long-term follow-up may have limited benefit for low-risk patients.
- Higher-risk groups (Politano-Leadbetter reimplantation, girls, preoperative reflux nephropathy) may benefit from extended follow-up.
Purpose:
To evaluate the incidence of late surgical complications and long-term kidney outcomes following ureteral reimplantation (UR) for high-grade vesicoureteral reflux (VUR) and primary obstructed megaureter (POM), assessing the necessity of routine long-term follow-up.
Methods:
A retrospective review was conducted of 135 children who underwent UR between 2006 and 2013, with at least 10 years of follow-up. Primary outcomes included postoperative ureterovesical junction obstruction (pUVJO) and febrile urinary tract infections (UTIs). Secondary outcomes assessed kidney function and morphology (renal ultrasound changes, elevated BUN/creatinine, and arterial hypertension).
Results:
Fifty-three renal units in 34 children met the inclusion criteria. pUVJO occurred in 7.5% of units, exclusively after Politano-Leadbetter (P-L) reimplantation, and within eight months postoperatively. Nine children experienced febrile UTIs, primarily within the first postoperative year. One child with reflux nephropathy (RN) developed chronic kidney disease 12 years later, and another developed RN without impaired function. No hypertension was observed in the cohort.
Conclusion:
Children with uneventful recoveries and no pUVJO in the first year have a low risk of late complications, suggesting limited benefit from routine long-term follow-up. Higher risk groups, including those undergoing P-L reimplantation, girls, and those with preoperative RN, may warrant extended follow-up.
