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Ureteral reimplantation in infants
S P Greenfield1, J J Griswold, J Wan
1Department of Urology, Children's Hospital of Buffalo, State University of New York.
The Journal of Urology
|November 1, 1993
Summary
Ureteral reimplantation surgery in infants successfully treated 93% of vesicoureteral reflux cases and avoided the need for urinary diversion. This procedure is a safe and effective option for infants requiring surgical intervention for urological abnormalities.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Urological Reconstruction
Background:
- Infantile urological conditions like primary vesicoureteral reflux (VUR) and ureterovesical junction (UVJ) obstruction require effective management.
- Ureteral reimplantation is a key surgical technique for correcting these abnormalities in infants.
- Minimizing the need for urinary diversion procedures is a primary goal in pediatric urological surgery.
Purpose of the Study:
- To evaluate the success rates and outcomes of ureteral reimplantation in infants with various underlying urological abnormalities.
- To assess the efficacy of different reimplantation techniques, including ureteral tapering.
- To determine the safety and long-term effectiveness of ureteral reimplantation in preventing reflux and obstruction.
Main Methods:
- Retrospective analysis of 30 infants (46 ureters) aged 8 weeks to 6 months undergoing ureteral reimplantation between 1984 and 1990.
- Procedures included Glenn-Anderson advancement, Cohen cross-trigonal advancement, and Politano-Leadbetter procedures, with 65% of ureters undergoing intravesical tapering.
- All patients received ureteral stents postoperatively; follow-up extended to 18 months.
Main Results:
- Postoperative reflux was absent in 93% (43/46) of ureters at 18-month follow-up.
- Surgical success rates were 90% for tapered ureters and 100% for non-tapered ureters.
- Transient obstruction occurred in 2 children post-stent removal; no permanent ureterovesical obstruction was observed.
Conclusions:
- Ureteral reimplantation is a highly successful surgical option for infants with primary VUR and selected cases of UVJ obstruction.
- The procedure achieves excellent success rates in resolving reflux and preventing obstruction, thereby avoiding the need for urinary diversion.
- While observation may suffice for some UVJ abnormalities, reimplantation offers a safe and effective solution when indicated in this young patient population.