Reflux Grade Is Associated with Postoperative Outcomes After Ureteral Reimplantation in Children: A Retrospective...

Vesicoureteral reflux (VUR) is a common pediatric urologic disorder associated with recurrent febrile urinary tract infections, renal scarring, hypertension, and potential long-term renal morbidity. Postoperative outcomes after ureteral reimplantation may be influenced by reflux grade, reflux etiology, bladder function, renal status, operative technique, surgeon experience, and follow-up intensity. However, real-world evidence from low- and middle-income healthcare settings remains limited, particularly for surgically treated children with high-grade VUR.

To describe postoperative outcomes after ureteral reimplantation in children with Grade III-V VUR and to explore the association of VUR grade and surgical approach with reflux resolution, recurrence, and reintervention in a surgically selected pediatric cohort.

We conducted a retrospective cohort study at a tertiary pediatric referral center in Ecuador. The study included 90 children aged 0 to 15 years with Grade III-V VUR confirmed by voiding cystourethrography who underwent open or laparoscopic ureteral reimplantation between January 2019 and January 2024. Demographic, clinical, imaging, and surgical variables were extracted from medical records. Postoperative outcomes included reflux resolution, recurrence, and reintervention. Logistic regression models were used as exploratory analyses only. Because the cohort included only operated patients, treatment allocation was nonrandomized, event numbers were limited, and several relevant prognostic variables were incompletely documented, adjusted estimates were interpreted cautiously and were not used to infer causality.

Overall reflux resolution was achieved in 68 of 90 patients (75.6%), recurrence occurred in 12 patients (13.3%), and reintervention was required in 8 patients (8.9%). Resolution rates were similar after open and laparoscopic surgery (44/59, 74.6% vs. 24/31, 77.4%; p = 0.766). Recurrence was numerically lower after laparoscopic than open reimplantation, but the difference was not statistically significant (2/31, 6.5% vs. 10/59, 16.9%; p = 0.164). Reintervention rates were also similar between groups (3/31, 9.7% vs. 5/59, 8.5%; p = 0.849). In exploratory multivariable analysis, Grade V VUR was associated with lower odds of reflux resolution (OR, 0.06; 95% CI, 0.01-0.40; p = 0.003) and higher odds of recurrence (OR, 16.69; 95% CI, 1.88-148.32; p = 0.012) compared with Grade III VUR. Surgical approach was not independently associated with resolution, recurrence, or reintervention. The small Grade V subgroup, the limited number of recurrence and reintervention events, and the wide confidence intervals indicate substantial statistical imprecision.

In this surgically treated pediatric cohort from a tertiary referral center in Ecuador, ureteral reimplantation was associated with reflux resolution in approximately three-quarters of patients. Higher reflux grade, particularly Grade V disease, was associated with less favorable postoperative outcomes in exploratory analyses, but these findings should not be interpreted as causal or definitive because of the small subgroup size, limited event numbers, selection bias, and incomplete documentation of reflux etiology, bladder dysfunction, renal scarring, renal function, surgeon experience, and follow-up duration. Open and laparoscopic approaches showed comparable resolution and reintervention rates, while the lower recurrence observed after laparoscopy did not reach statistical significance. Future prospective studies should standardize outcome definitions, distinguish imaging-confirmed from clinically documented resolution, report follow-up duration, and account for reflux etiology, bladder function, renal status, surgical experience, and healthcare access.