The effectiveness of ureteric reimplantation during bladder augmentation for high-grade vesicoureteric reflux in patients with neurogenic bladder: long-term outcome.
OBJECTIVE
The outcome of ureteric reimplantation (UR) during bladder augmentation (BA) for high-grade vesicoureteric reflux (HVUR) in patients with neurogenic bladder was assessed to determine the effectiveness of UR. A literature review of HVUR and BA was also performed.


METHODS
Twenty-two consecutive sigmoidocolocystoplasty patients were reviewed retrospectively; 10 had unilateral HVUR only, 3 had bilateral HVUR, and 9 had unilateral HVUR associated with low-grade VUR in the contralateral renal unit (RU). Preoperatively, VUR was grade V in 3 RU, grade IV in 22 RU, grade III in 5 RU, and grade II in 4 RU. Ureteric reimplantation was performed in the native bladder in 24 RU (16 patients) and in the colon cap in 10 RU (6 patients).


RESULTS
Mean age at sigmoidocolocystoplasty/UR was 8.5 years (range, 2-15 years). Mean follow-up was 12.8 years (range, 2-22 years). Postoperatively, cystourethrography showed residual VUR (grade IV to grade III) in only 1 RU (3%); diethylenetriamine pentaacetic acid scintigraphy showed no obstruction in all RU; (99m)Tc-dimercaptosuccinic acid was improved in 13 RU, unchanged in 18 RU, and worsened in 3 RU; and serum creatinine remained normal in 20 patients and worsened in 2. Urinary tract infection, universal preoperatively, was seen postoperatively in only 2 patients. In the literature, 0% to 16.7% of HVUR persisted after BA alone, and no long-term data were available.


CONCLUSIONS
Ureteric reimplantation during BA is safe and effective for treating HVUR in patients with neurogenic bladder.
Hayashi
Yutaka
Y
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
Kato
Yoshifumi
Y
Okazaki
Tadaharu
T
Lane
Geoffrey J
GJ
Kobayashi
Hiroyuki
H
Yamataka
Atsuyuki
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012092:Replantation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000175:diagnosis / Q000601:surgery*