title: Common sheath reimplantation yields excellent results in the treatment of vesicoureteral reflux in duplicated collecting systems.
abstract: OBJECTIVE
  We evaluated our 10-year experience with the surgical treatment of vesicoureteral reflux in uncomplicated duplicated collecting systems.
  
  
  METHODS
  Between 1984 and 1994, 54 refluxing renal units (8 bilateral) in 37 female and 9 male patients required surgery. Patient age ranged from 7 months to 17 years (average 4.9 at surgery). Postoperative followup (average 14.2 months) included voiding cystourethrography and renal sonography or excretory urography.
  
  
  RESULTS
  Common sheath ureteral reimplantation via an intravesical approach was performed in 48 of the 54 refluxing renal units. Of the remaining 6 renal units detrussorrhaphy was performed in 4, and ureteroureterostomy combined with ureteral reimplantation and partial lower pole nephrectomy were done in 1 each. Two treated renal units had persistent postoperative vesicoureteral reflux, which resolved after subureteral polytetrafluoroethylene (Teflon) injection. No renal had postoperative hydronephrosis. Contralateral reflux was identified in 1 patient who underwent unilateral reimplantation. Our overall success rate was 96% for the surgical correction of vesicoureteral reflux in uncomplicated duplicated collecting systems. Common sheath reimplantation had a 98% success rate.
  
  
  CONCLUSIONS
  Although a duplicated collecting system increases the risk for surgical treatment, the presence of a duplication anomaly does not adversely affect surgical outcome. Modifications of procedures commonly performed in the surgical treatment of single system reflux to accommodate common sheath reimplantation have excellent surgical results with minimal morbidity.
authors.affiliation: Nemours Children's Clinic, University of Florida, Gainesville, Florida 32610-0247, USA.
authors.forename: P I
authors.initials: PI
authors.lastname: Ellsworth
authors.forename: D J
authors.initials: DJ
authors.lastname: Lim
authors.forename: R D
authors.initials: RD
authors.lastname: Walker
authors.forename: P S
authors.initials: PS
authors.lastname: Stevens
authors.forename: M A
authors.initials: MA
authors.lastname: Barraza
authors.forename: H G
authors.initials: HG
authors.lastname: Mesrobian
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012092:Replantation; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*