title: Augmentation cystoplasty and simultaneous ureteral reimplantation reduce high-grade vesicoureteral reflux in children with neurogenic bladder.
abstract: BACKGROUND
  To compare the incidence of residual high-grade vesicoureteral reflux (HVUR) (≥Grade III) in neurogenic bladder patients receiving augmentation cystoplasty alone or with simultaneous ureteral reimplantation. Furthermore, we also tried to find the risk factors of residual VUR and febrile urinary tract infection.
  
  
  METHODS
  Between 1999 and 2009, urinary bladder augmentation was performed in 21 children with neurogenic bladder. Seventeen of these patients had VUR on preoperative voiding cystourethrography, of whom 11 patients (14 ureters) received augmentation alone (Group A) and 6 patients (8 ureters) received simultaneously ureteral reimplantation (Group B). Univariate logistic regression analysis and Fisher exact test were used for statistical analysis.
  
  
  RESULTS
  Six patients (8 ureters) had residual HVURs in Group A, but none in Group B. The incidences of residual HVUR were 57.14% and 0%, respectively. Seven patients had febrile UTIs after operation, 6 of them had residual HVURs. In risk factor analysis, postoperative follow-up duration less than 12 months and lack of anti-reflux operation were significant risk factors for residual HVUR; the residual HVUR was the significant risk factor for febrile urinary tract infection.
  
  
  CONCLUSIONS
  Simultaneous ureteral reimplantation reduces postop HVUR significantly. We recommend augmentation and simultaneous ureteral reimplantation in children with HVUR and neurogenic bladder if technically feasible.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taiwan, ROC.
authors.forename: Jen-Bin
authors.initials: JB
authors.lastname: Wang
authors.forename: Chin-Su
authors.initials: CS
authors.lastname: Liu
authors.forename: Shin-Lin
authors.initials: SL
authors.lastname: Tsai
authors.forename: Chou-Fu
authors.initials: CF
authors.lastname: Wei
authors.forename: Tai-Wai
authors.initials: TW
authors.lastname: Chin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012092:Replantation; D012189:Retrospective Studies; D012307:Risk Factors; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology; D014718:Vesico-Ureteral Reflux / Q000517:prevention & control*