Ureteroneocystostomy in the treatment of reflux in neurogenic bladders

There were 15 patients with neurogenic bladders, representing 23 renal units with reflux, who underwent reimplantation with the Politano-Leadbetter technique. The over-all success rate was 30 per cent. Failures, including persistent reflux or obstruction, were demonstrated on at least 1 side of all bilateral reimplantations and 3 of 7 unilateral procedures. These results are compared to those in the recent literature. We conclude that case selection, limiting the operation to only those patients with balanced bladders, will ensure uniformly good results. External sphincterotomy in patients with reflux may alter the clinical course, either obviating the need for reimplantation or creating a balanced bladder. Other forms of therapy, such as urinary diversion, are indicated only in those patients who persist with markedly abnormal bladders and renal deterioration.