title: Urodynamic findings and functional or anatomical obstructions in children who developed bladder diverticula after reimplantation of the ureter.
abstract: OBJECTIVE
  To study the clinical and urodynamic parameters of children who developed bladder diverticula (BD) after ureteral reimplantation.
  
  
  METHODS
  We have reviewed records of 15 children who underwent ureteric reimplantation, possibly with diverticulectomy between January 1998 and October 2004, who postoperatively developed BD and compared the results with 25 patients, surgically treated for primary vesicoureteric reflux (VUR) without BD development after reimplantation. A total of 737 reimplantations was performed in 492 patients. Of the 15 patients and 25 controls we reviewed voiding history and free uroflowmetry, urodynamic parameters, findings on urethrocystoscopy, VCUG and signs of dysfunctional or anatomical obstruction.
  
  
  RESULTS
  Of the fifteen patients with a postoperative diverticulum, one patient (7%) had an infravesical obstruction in combination with a normal voiding pattern, nine patients (60%) had severe dysfunctional voiding and two patients (13%) had both. Three patients had no infravesical obstruction nor dysfunctional voiding. Urodynamically the mean Pmax postoperatively was 96.8 (cm-H(2)O) in the obstructed patients (BD-group) (in controls 50.0 cm-H(2)O) and 95.6 (cm-H(2)O) for the dysfunctional voiders (in controls 61.8 cm-H(2)O). The difference between the Pmax values of BD-group and controls was significant on the 95% C.I. (P < 0.01).
  
  
  CONCLUSIONS
  Dysfunctional voiding and infravesical obstruction in children appear to be important risk factors for acquired BD. Voiding pressures are significantly higher in patients that developed BD. Cognitive bladder training to normalize voiding pressures should be done before surgery if feasible. Special attention should be paid to the persistence of an infravesical obstruction.
authors.affiliation: University Children's Hospital UMC Utrecht, Pediatric Renal Center, Utrecht, The Netherlands. mec.tilanus@gmail.com
authors.forename: Martijn
authors.initials: M
authors.lastname: Tilanus
authors.forename: Aart
authors.initials: A
authors.lastname: Klijn
authors.forename: Pieter
authors.initials: P
authors.lastname: Dik
authors.forename: Laetitia
authors.initials: L
authors.lastname: de Kort
authors.forename: Tom
authors.initials: T
authors.lastname: de Jong
mesh_terms: D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology*; D012092:Replantation; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology* / Q000601:surgery*; D014518:Ureterocele / Q000473:pathology / Q000601:surgery; D001743:Urinary Bladder / Q000473:pathology* / Q000601:surgery*; D014555:Urination Disorders / Q000453:epidemiology / Q000209:etiology; D014563:Urodynamics / Q000502:physiology*; D014718:Vesico-Ureteral Reflux / Q000473:pathology / Q000601:surgery