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Ureteric orifice deformation causing secondary reflux

C M Kullendorff

    Scandinavian Journal of Urology and Nephrology
    |January 1, 1982
    PubMed
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    Posterior urethral valve surgery can cause vesicoureteric reflux due to ureteric orifice issues. Transurethral diathermy to correct mucosal bridges resolved reflux permanently in two pediatric patients.

    Area of Science:

    • Pediatric Urology
    • Surgical Innovation
    • Vesicoureteric Reflux Management

    Background:

    • Posterior urethral valves (PUV) are a common congenital anomaly in male infants, often requiring surgical intervention.
    • Ureteroneocystostomy, a procedure to reimplant the ureters, is used to treat associated complications like vesicoureteric reflux (VUR).
    • The Politano-Leadbetter technique is a standard surgical approach for ureteroneocystostomy.

    Observation:

    • Two male infants with PUV and dilated ureters underwent Politano-Leadbetter ureteroneocystostomy at 4 and 6 months of age.
    • Postoperatively, both patients developed significant vesicoureteric reflux.
    • Endoscopic evaluation identified a mucosal bridge between the medial aspects of the ureteric orifices in both cases.

    Findings:

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  • Transurethral endoscopic diathermy was utilized to transect the identified mucosal bridges.
  • Following the endoscopic intervention, vesicoureteric reflux resolved permanently in both patients.
  • The study suggests that ureteric orifice fixation and deformation secondary to surgery may contribute to postoperative reflux.

    • Implications:

    • Endoscopic management of ureteric orifice mucosal bridges offers a minimally invasive solution for refractory postoperative VUR.
    • This approach may prevent the need for further complex reconstructive surgery.
    • Routine endoscopic assessment is recommended for children experiencing VUR after ureteroneocystostomy.