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Lessons learned about contralateral reflux after unilateral extravesical ureteral advancement in children
D K Burno1, D B Glazier, M R Zaontz
1Section of Pediatric Urology, Children's Regional Hospital at Cooper Hospital-University Medical Center, Camden, New Jersey, USA.
Insights
Contralateral reflux after unilateral antireflux surgery in children often resolves with conservative management. Bilateral reimplantation is not recommended for unilateral reflux with a history of resolved contralateral reflux.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Reflux Management
Background:
- Contralateral reflux following unilateral antireflux surgery presents diagnostic and management challenges.
- Understanding the natural history and resolution patterns of contralateral reflux is crucial.
Purpose of the Study:
- To evaluate the incidence and resolution of contralateral reflux after unilateral extravesical ureteral advancement in children.
- To inform management strategies for children undergoing unilateral antireflux surgery.
Main Methods:
- Retrospective review of pediatric patients who underwent unilateral extravesical ureteral advancement over a 7-year period.
- Analysis of new-onset and recurrent contralateral reflux, including resolution rates with observation.
Main Results:
- Contralateral reflux developed in 11.6% of patients post-unilateral reimplantation.
- New-onset contralateral reflux resolved in one child with observation.
- Among children with a history of resolved contralateral reflux, recurrence was observed, but most cases resolved conservatively.
Conclusions:
- Recurrent contralateral reflux after unilateral reimplantation typically resolves with conservative management.
- Bilateral reimplantation is not indicated for unilateral reflux with a history of resolved contralateral reflux.
- Observation is the recommended approach for recurrent contralateral reflux, as it is likely to resolve spontaneously.
Purpose:
The development of contralateral reflux after unilateral antireflux surgery has spawned interest and controversy regarding etiology and management issues. We evaluate our experience to understand better the issues surrounding contralateral reflux.
Materials And Methods:
We retrospectively reviewed the records of all children seen in a 7-year period who underwent unilateral extravesical ureteral advancement performed by one of us (M. R. Z.) at our institution.
Results:
A total of 43 children a mean of 50.5 months old underwent unilateral reimplantation. The male-to-female ratio was 12:31. In 12 children contralateral reflux had resolved preoperatively. Overall contralateral reflux developed in 5 patients (11.6%) after unilateral extravesical ureteral advancement. In 1 child in whom new onset contralateral reflux developed on 1 side reflux resolved by 10 months with observation. In 8 of the 12 children (66%) with a history of resolved contralateral reflux there was no recurrence. In 4 of the 12 children recurrent contralateral reflux completely resolved by 14 months postoperatively with only observation. In these 4 patients initial reflux had been grades II and IV in 2 each. To date all fully evaluable reflux in children with previous contralateral reflux recurred has resolved.
Conclusions:
The recurrence of contralateral reflux after unilateral reimplantation that is expected in a small number of children resolves in the majority, if not in all, with conservative management. We believe that children should not be offered bilateral reimplantation for unilateral reflux and a history of resolved contralateral reflux. If contralateral reflux recurs, it will most likely resolve with time.