Ureteroneocystostomy after failed dextranomer/hyaluronic acid copolymer injection for vesicoureteral reflux treatment.
OBJECTIVE
To report our experience of open ureteroneocystostomy after failed endoscopic treatment.


METHODS
Clinical charts of 787 children who entered our dextranomer/hyaluronic acid copolymer (DxHA) endoscopic injection program for vesicoureteral reflux (VUR) treatment between May 2000 and December 2009 were reviewed. Fifty-one of these patients were submitted to open ureteroneocystostomy for complete resolution of VUR.


RESULTS
Twenty-eight patients (55%) were female. Median age at surgery was 65 months (range: 26-182). Median time going from first endoscopic injection until open surgery was 13 months (range 1-58). Surgical ureteral reimplantation was bilateral in 62.7% of the cases. Of a total of 83 operated ureters, nine were duplex ureters, nine were megaureters, six were ectopic, and two had periureteral diverticulum. Mean operative time was 70 min (range 45-120 min). There were no intra-operative complications. Follow-up VCUG showed complete resolution of VUR in 98% of patients. There was only one right-sided grade III VUR that persisted after bilateral reimplantation. It resolved with a single subureteral DxHA injection.


CONCLUSIONS
Ureteroneocystostomy after a failed endoscopic treatment can achieve successful results in a high percentage of patients with minimal complications.
Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. moreirapinto@gmail.com
João
J
Moreira-Pinto
Angélica
A
Osório
Joana
J
Pereira
Catarina
C
Sousa
João Luís Ribeiro
JL
de Castro
Armando
A
Réis
D000293:Adolescent; D001672:Biocompatible Materials; D002648:Child; D002675:Child, Preschool; D003559:Cystostomy / Q000379:methods*; D003911:Dextrans / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007223:Infant; D007267:Injections / Q000379:methods; D008297:Male; D019233:Retreatment; D012189:Retrospective Studies; D017211:Treatment Failure; D014519:Ureterostomy / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy* / Q000601:surgery*
D001672:Biocompatible Materials; D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid