Urinary retention after bilateral extravesical ureteral reimplantation: does dissection distal to the ureteral orifice have a role?
OBJECTIVE
We evaluated the outcome and incidence of urinary retention after bilateral detrusorrhaphy using 2 modifications of the original Lich-Gregoir procedure.


METHODS
We evaluated the charts of 220 patients who underwent correction of bilateral vesicoureteral reflux using the extravesical approach from January 1991 to December 1997. Inverted Y detrusorrhaphy was performed in 154 patients and the advancing suture modification was done in 66.


RESULTS
The success rate using the advancing suture technique was 92.4 and 95.4% at 3 and 12 months, respectively. The Y detrusorrhaphy technique was successful in 91.6 and 97.4% of cases at 3 and 12 months, respectively. The difference in the techniques was not statistically significant. Urinary retention developed in 8.4% of the patients who underwent Y detrusorrhaphy compared to 15.2% of those who underwent the advancing suture technique (not statistically significant). However, patients with grades IV and V reflux, children younger than 3 years and boys had significantly (p <0.05) higher postoperative retention rates of 24.6, 35.6 and 20.3%, respectively, when all 220 patients were considered.


CONCLUSIONS
Each modification of the original Lich-Gregoir technique is highly effective for treating bilateral vesicoureteral reflux and each is associated with a low rate of temporary urinary retention. Although there seems to be a lower incidence of retention with the Y detrusorrhaphy technique, this was not statistically significant. Because of the higher incidence of urinary retention in young children, boys and/or patients with high grade reflux, we recommend that physicians consider a longer period of catheterization regardless of the technique chosen.
Barrieras
D
D
Hospital for Sick Children, University of Toronto, Ontario, Canada.
Lapointe
S
S
Reddy
P P
PP
Williot
P
P
McLorie
G A
GA
Bägli
D
D
Khoury
A E
AE
Merguerian
P A
PA
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012092:Replantation; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*