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 complex is expected to resolve after augmentation, which decreases the intravesical pressure and increases capacity.


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.
Division of Paediatric Urology, Department of Paediatric Surgery, Cerrahpasa Medical Faculty, University of Istanbul, D:23/3 (80220) Nisantasi, Istanbul, Turkey. ysoylet@superonline.com
Yunus
Y
Soylet
Haluk
H
Emir
Zekeriya
Z
Ilce
Ebru
E
Yesildag
S N Cenk
SN
Buyukunal
Nur
N
Danismend
D002648:Child; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000150:complications; D014718:Vesico-Ureteral Reflux / Q000601:surgery*