[Stenosis and reflux after surgery of the ureterovesical junction in children. Indications and results of reoperation. Apropos of 460 ureterovesical reimplantations].
Implantation of 460 ureters into bladder was performed in 278 children (68 boys, 210 girls) age range 3 months to 15 years. The operative technique used was generally that of Cohen (335 cases), more rarely that of Leadbetter-Politano (118 cases) and very exceptionally that of Lich-Gregoir (7 cases). Indications for surgery included: so-called "essential" reflux: 373 cases, reflux with Hutch's diverticulum: 20 cases, ureterocele: 14 cases, megaureter: 25 cases (including 14 "modelled" as described by Hendren), neurologic bladder: 10 cases, urethral valves: 7 cases, ectopic openings: 6 cases and multiple malformations: 3 cases. Results in antireflux ureterovesical implantations of 427 ureters were good but complications included 18 cases of stenosis and 9 with persistent reflux. Etiology of these unsuccessful cases, as described by H. Hendren, is discussed and indications and operative techniques for recovery surgery analyzed. Treatment in unsuccessful cases included nephrectomy for stenosis, skin shunt operation for neurologic bladder, a repeat Cohen operation and 8 repeat L.P. operations, with 8 successful results and one failure. Recurrence of reflux was treated in one case by interpyelic anastomosis on duplication, in 2 cases by Cohen's operation and twice by L.P.'s operation, with success in 4 cases. Five patients with stenosis and one with reflux were stabilized and recovery operation was not performed. Finally three patients with unsuccessful initial operation were lost to view.
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D008297:Male; D011183:Postoperative Complications; D012086:Reoperation; D012092:Replantation; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000209:etiology* / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000209:etiology* / Q000601:surgery
Sténoses et reflux après chirurgie de la jonction urétéro-vésicale chez l'enfant. Indications et résultats des réinterventions. A propos de 460 réimplantations urétéro-vésicales.