title: Should simultaneous ureteral reimplantation be performed during sigmoid bladder augmentation to reduce vesicoureteral reflux in neurogenic bladder cases?
abstract: OBJECTIVE
  To assess the necessity of performing simultaneous collateral reimplantation during sigmoid bladder augmentation (SBA) to reduce vesicoureteral reflux (VUR) in low-compliance neuropathic bladder with associated VUR.
  
  
  METHODS
  We retrospectively identified 31 patients who underwent SBA alone or with simultaneous ureteral reimplantation at our hospital. The video urodynamics data, VUR status, renal function, and clinical symptoms were studied during follow-up.
  
  
  RESULTS
  The mean follow-up time was 57 months (range 12-117). All patients displayed significantly increased safe cystometric capacity (P < 0.001) and bladder compliance (P < 0.001) and decreased creatinine (P < 0.01) and urea nitrogen (P < 0.05) compared with preoperative levels. High-grade VUR was resolved in only 7 of 15 patients (47%) in Group A (simultaneous ureteral reimplantation), whereas low-grade VUR was resolved in 13 of 16 patients (81%) in Group B (SBA alone). The other 11 patients still displaying VUR after SBA had larger safe bladder volumes due to augmentation. The patients' improving renal function benefited most from the enlarged bladder and partly from increased antireflux resistance of vesico-ureter anastomosis. Twelve (38.7%) had recurrent febrile urinary tract infection after SBA, and one (3.2%) suffered from vesico-ureter anastomosis contracture after ureteral reimplantation.
  
  
  CONCLUSIONS
  A preoperative intravesical VUR pressure of 20 cmH2O is not an effective cutoff point for whether ureteral reimplantation should be simultaneously performed during SBA. Augmentation appears to be more important than reimplantation for protecting kidney from damage due to febrile urinary tract infection after SBA. Simultaneous reimplantation may be not necessary during SBA in neurogenic bladder.
authors.affiliation: Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China, seabottlezp@126.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.forename: Yong
authors.initials: Y
authors.lastname: Yang
authors.forename: Zhi-jin
authors.initials: ZJ
authors.lastname: Wu
authors.forename: Ning
authors.initials: N
authors.lastname: Zhang
authors.forename: Chao-hua
authors.initials: CH
authors.lastname: Zhang
authors.forename: Xiao-dong
authors.initials: XD
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D012809:Colon, Sigmoid / Q000637:transplantation; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011312:Pressure; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
chemical_list: D003404:Creatinine
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