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Ureteral reimplantation in children with neurogenic bladder
Insights
Ureteroneocystostomy surgery effectively treats vesico-ureteral reflux in children with myelomeningocele, preserving kidney function and reducing infections. This approach is preferred over permanent urinary diversion for managing neurogenic bladder complications.
Area of Science:
- Pediatric Urology
- Neurosurgery
- Reconstructive Surgery
Background:
- Myelomeningocele frequently causes urologic complications, notably vesico-ureteral reflux and neurogenic bladder.
- Management of these complications, particularly vesico-ureteral reflux, remains a significant clinical challenge.
Purpose of the Study:
- To evaluate the efficacy of ureteroneocystostomy with technical innovations for treating vesico-ureteral reflux and uretero-vesical junction obstruction.
- To assess the impact of this surgical approach on upper urinary tract dilatation and renal function in children with myelomeningocele.
Main Methods:
- A series of 26 ureteral reimplantations in 17 children with myelomeningocele.
- Surgical technique involved ureteroneocystostomy with specific innovations.
- Pre-operative management included urethral dilatation, sphincterotomy, and pharmacologic regulation.
Main Results:
- Over 85% good results reported in the series.
- Successful elimination of vesico-ureteral reflux.
- Decreased upper urinary tract dilatation and preserved renal function in most cases.
- Improved control of urinary tract infections.
Conclusions:
- Ureteroneocystostomy is a viable and effective surgical option for vesico-ureteral reflux and uretero-vesical junction obstruction in neurogenic bladders associated with myelomeningocele.
- This surgical method offers advantages over permanent urinary diversion, including improved infection control and preservation of renal function.
- Post-operative bladder re-education can be attempted following successful surgical outcomes.
Abstract:
The treatment of urologic complications from myelomeningocele and especially of vesico-renal reflux is a controversial problem. A series of 26 reimplanted ureters in 17 children, with good results in more than 85%, is reported. Ureteroneocystostomy, carried out with a few technical innovation, may represent a useful method for the treatment of vesico-renal reflux and obstruction of the uretero-vesical junction in neurogenic bladder associated with myelomeningocele. This surgical approach leads to the disappearance of the reflux, decrease of dilatation of the upper urinary tract and preservation of renal function in most cases; moreover, infection can be more easily controlled. Ureteral reimplantation should be preceded by periodic urethral dilatation, external transurethral sphincterotomy, and pharmacologic regulation in order to attempt to decrease urethral resistance. After successful surgery, it is possible to try to reeducate the bladder. Reimplantation should be preferred to permanent urinary diversion even if there is gross reflux.