[Factors related to postoperative hydronephrosis following ureteroneocystostomy in neurogenic bladders]

A total of 68 ureteroneocystostomies performed between 1980 and 1992 in 63 patients with vesicoureteral reflux (UVR) secondary to neurogenic bladder were reviewed to elucidate factors of postoperative hydronephrosis. Urogram, cystogram, and urodynamics were analyzed, and the cases were classified into two types (areflexia, hyperreflexia) of detrusor muscle response. Occurrence or progression of hydronephrosis was demonstrated in 26 operations (complicated group). Compared with the rest (uncomplicated group), significant difference was not observed concerning proportions of vesical deformity, VUR grades, preoperative hydronephrosis, cystometric types and operative factors. In cases of hyperreflexia maximum vesical volume, maximum vesical pressure or maximum urethral pressure was not different between both groups. However, in those of areflexia maximum vesical volume of the complicated group was significantly smaller than that of the uncomplicated group (290 +/- 35 ml vs. 370 +/- 35 ml, P = 0.03), and the proportion of bladders with compliance less than 10 ml/cmH2O was significantly higher in the complicated group than in the uncomplicated group (P = 0.05) though maximum vesical pressure or maximum urethral pressure was not different. In areflex bladder deformity was observed more in the complicated group than in the uncomplicated group (P = 0.06). Relative inactiveness of detrusor muscle in areflex bladder might render such preoperative findings as vesical deformity, contracted bladder and low compliance more prognosticative of postoperative hydronephrosis than in hyperreflex bladder. During the follow up (6 to 132, mean 42 months) no case showed progression of hydronephrosis or renal deterioration, nor did any case require revisional surgery.(ABSTRACT TRUNCATED AT 250 WORDS)