Quo vadis? Ureteric reimplantation or ignoring reflux during augmentation cystoplasty

OBJECTIVE To decide whether antireflux surgery should be used in the presence of vesico‐ureteric reflux (VUR) in children, in whom an augmentation procedure is needed, because secondary VUR in children with a neurogenic bladder, infravesical obstruction and primary VUR in the exstrophy‐epispadias co...

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Bibliographic Details
Published in:BJU international 2004-08, Vol.94 (3), p.379-380
Main Authors: Soylet, Yunus, Emir, Haluk, Ilce, Zekeriya, Yesildag, Ebru, Buyukunal, S.N. Cenk, Danismend, Nur
Format: Article
Language:English
Subjects:
augmentation cystoplasty
Biological and medical sciences
bladder
Child
Cystectomy - methods
exstrophy‐epispadias
Female
Follow-Up Studies
Humans
infravesical obstruction
Male
Malformations of the urinary system
Medical sciences
Nephrology. Urinary tract diseases
neurogenic
Replantation - methods
Retrospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Ureter - surgery
Urinary Bladder, Neurogenic - complications
Urinary tract. Prostate gland
Vesico-Ureteral Reflux - surgery
vesico‐ureteric reflux
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Summary:OBJECTIVE To decide whether antireflux surgery should be used in the presence of vesico‐ureteric reflux (VUR) in children, in whom an augmentation procedure is needed, because secondary VUR in children with a neurogenic bladder, infravesical obstruction and primary VUR in the exstrophy‐epispadias complex is expected to resolve after augmentation, which decreases the intravesical pressure and increases capacity. PATIENTS AND METHODS Between 1987 and 2001, the bladder was augmented in 38 children, using no antireflux surgery in group 1 (15 patients) and antireflux surgery in group 2 (23 patients). RESULTS VUR was detected in all patients on cysto‐urethrography before surgery; reflux resolved after augmentation cystoplasty in 97% and 93% of refluxing units in groups 1 and 2, respectively. The increase in the expected bladder capacity was from 35% to 86% in group 1 and from 38% to 90% in group 2. No patient had any deterioration in renal function. CONCLUSIONS We recommend using only augmentation in patients with low‐ or high‐grade VUR and a neurogenic bladder, infravesical obstruction and exstrophy‐epispadias. Combining antireflux surgery with cystoplasty has no significant effect on either the resolution of VUR or renal function.
ISSN:1464-4096
1464-410X
DOI:10.1111/j.1464-410X.2004.04965.x