title: The mechanism of new onset contralateral reflux following unilateral ureteroneocystostomy.
abstract: OBJECTIVE
  We studied a population of patients undergoing unilateral antireflux surgery to determine the mechanism of new onset contralateral reflux postoperatively.
  
  
  METHODS
  A total of 141 patients underwent unilateral antireflux surgery via the Cohen, Glenn-Anderson or extravesical technique. The 18% of patients who had new onset contralateral vesicoureteral reflux were analyzed according to grade of initial reflux, presence of a Hutch diverticulum or duplex system and surgical technique.
  
  
  RESULTS
  Surgical technique did not influence the development of contralateral reflux. As grade of corrected reflux increased, a significant trend toward development of contralateral reflux was noted. A Hutch diverticulum was not a risk factor for contralateral reflux but reflux into a duplicated system was a distinct risk factor (26 versus 12% in single system reflux).
  
  
  CONCLUSIONS
  Our study supports the concept that new onset contralateral reflux may result from elimination of a pop-off mechanism. Surgical distortion of the contralateral hemi-trigone appears not to be responsible. Correction of severe (grade V) reflux and reflux into duplex systems put patients at particular risk for development of contralateral reflux postoperatively.
authors.affiliation: University of Massachusetts Medical Center, Worcester, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Diamond
authors.forename: R
authors.initials: R
authors.lastname: Rabinowitz
authors.forename: D
authors.initials: D
authors.lastname: Hoenig
authors.forename: A A
authors.initials: AA
authors.lastname: Caldamone
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003559:Cystostomy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*