Unilateral ureteral reimplantation and management of contralateral low grade or resolved vesicoureteral reflux.
OBJECTIVE
New contralateral vesicoureteral reflux after unilateral ureteral reimplantation is well described in the literature. Management of high grade vesicoureteral reflux with resolved contralateral reflux is less extensively studied. Most surgeons perform a bilateral procedure in these cases. We report the results when an open procedure was deferred on the contralateral side.


METHODS
A retrospective cohort study was performed of all patients with unilateral vesicoureteral reflux undergoing ureteral reimplantation performed by 1 surgeon between 2003 and 2012. Resolved or low grade contralateral reflux was observed if the kidney was normal. Dextranomer/hyaluronic acid copolymer injection was also offered for persistent grade I contralateral reflux. Outcomes were abstracted from the medical record and compared to those in patients undergoing bilateral ureteral reimplantation.


RESULTS
Of 78 patients undergoing unilateral ureteral reimplantation 15 met inclusion criteria. Median age was 5.5 years, and median followup was 7.6 years. Extravesical detrusorrhaphy was performed in all cases. The 15 study patients initially had contralateral reflux that either resolved (8) or persisted as grade I (7). Six patients had results on 2 cystograms that were negative for contralateral reflux before ureteral reimplantation. Length of stay was 1 day less and costs were 59% lower for patients undergoing unilateral vs bilateral ureteral reimplantation. Postoperatively 2 of 15 patients (13%) had an afebrile urinary tract infection. All 15 patients had normal contralateral kidneys on postoperative ultrasound.


CONCLUSIONS
Observation of contralateral resolved or low grade vesicoureteral reflux at unilateral ureteral reimplantation is feasible, with minimal morbidity and a shorter hospital stay compared to performance of bilateral ureteral reimplantation. This approach appears to be a reasonable option to discuss with parents during preoperative counseling.
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: bob.defoor@cchmc.org.
William
W
DeFoor
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Lori
L
Hazelwood
D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007267:Injections; D008297:Male; D011183:Postoperative Complications; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000637:transplantation*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid
cystostomy; ureterostomy; urinary bladder; vesico-ureteral reflux