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Contralateral vesicoureteral reflux after simple and tapered unilateral ureteroneocystostomy revisited
A C McCool1, L M Pérez, D B Joseph
1Division of Urology, University of Alabama at Birmingham, Children's Hospital 35233, USA.
Insights
Contralateral vesicoureteral reflux is rare after unilateral ureteroneocystostomy, affecting only 1.4% with standard repair and 5.3% with tapered repair. Preoperative factors like reflux grade or ureteral orifice appearance did not influence its development.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Vesicoureteral Reflux
Background:
- Unilateral ureteroneocystostomy is a common surgical procedure for vesicoureteral reflux.
- Understanding the risk of contralateral vesicoureteral reflux is crucial for patient management.
Purpose of the Study:
- To evaluate the incidence and potential risk factors of contralateral vesicoureteral reflux following unilateral ureteroneocystostomy.
Main Methods:
- Retrospective review of 88 children undergoing unilateral ureteroneocystostomy (1986-1995).
- Comparison of standard repair (69 patients) versus tapered repair (19 patients).
- Preoperative cystoscopy and postoperative follow-up for reflux assessment.
Main Results:
- Contralateral vesicoureteral reflux developed postoperatively in 1.4% of standard repair and 5.3% of tapered repair cases.
- Ipsilateral reflux persisted in 21% of tapered repair cases but was corrected in all standard repair cases.
- Preoperative factors including reflux grade, renal duplication, and ureteral orifice appearance were not significantly associated with contralateral reflux.
Conclusions:
- Contralateral vesicoureteral reflux is an uncommon complication of unilateral ureteroneocystostomy.
- The development of contralateral reflux appears independent of preoperative reflux severity, renal duplication, or ureteral orifice morphology.
Purpose:
We reviewed our experience with contralateral vesicoureteral reflux following unilateral ureteroneocystostomy.
Materials And Methods:
We retrospectively identified 88 children who underwent unilateral ureteroneocystostomy from 1986 through 1995, including standard repair in 69 and tapered repair in 19. Cystoscopy was performed in all cases immediately before repair.
Results:
Grades IV to V vesicoureteral reflux was identified preoperatively in 34% of the patients, including 13 (19%) and 14 (74%) who underwent standard and tapered repair, respectively. Renal duplication was noted in 24% of the cases, including 18 standard (26%) and 3 tapered (16%) repairs. An abnormal contralateral nonrefluxing ureteral orifice was present in 8 of the 53 standard (15%) and 3 of the 14 (21%) tapered cases. Ipsilateral reflux was corrected in all children undergoing standard repair but it persisted in 4 (21%) in the tapered repair group. Postoperatively contralateral vesicoureteral reflux developed in 1 child (1.4%) in the standard and 1 (5.3%) in the tapered repair group.
Conclusions:
Contralateral vesicoureteral reflux is rare and does not appear to be influenced by preoperative reflux grade, a duplicated system or the endoscopic appearance of the ureteral orifice.