579 DURABILITY OF ANTI-REFLUX EFFECT OF URETERAL REIMPLANTATION FOR PRIMARY VESICOURETERAL REFLUX: ANALYSIS OF FINDINGS ON LONG-TERM CYSTOGRAPHY

Abstract

You have accessJournal of UrologyPediatrics: Imaging/Infections & Vesicoureteral Reflux1 Apr 2011579 DURABILITY OF ANTI-REFLUX EFFECT OF URETERAL REIMPLANTATION FOR PRIMARY VESICOURETERAL REFLUX: ANALYSIS OF FINDINGS ON LONG-TERM CYSTOGRAPHY Katherine Hubert, Paul Kokorowski, Lin Huang, Michaella Prasad, Ilina Rosoklija, Alan Retik, and Caleb Nelson Katherine HubertKatherine Hubert Boston, MA More articles by this author , Paul KokorowskiPaul Kokorowski Boston, MA More articles by this author , Lin HuangLin Huang Boston, MA More articles by this author , Michaella PrasadMichaella Prasad Boston, MA More articles by this author , Ilina RosoklijaIlina Rosoklija Boston, MA More articles by this author , Alan RetikAlan Retik Boston, MA More articles by this author , and Caleb NelsonCaleb Nelson Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1389AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The results of open ureteral reimplantation (UR) for primary vesicoureteral reflux (VUR) are excellent. However, there have been few studies documenting the long-term durability of UR results. This is particularly relevant for comparisons with results of endoscopic treatment. We sought to describe long-term cystography (LTC) results among children with a history of successful UR for primary VUR. METHODS We performed a retrospective chart review of all patients with primary VUR who underwent successful UR at our institution between January 1990 and December 2002. Successful UR was defined as absence of VUR (grade 0) into the reimplanted ureter(s) on routine screening cystogram within 6 months of surgery. We then analyzed those patients with successful UR to identify those who underwent LTC (RNC or VCUG performed at least 1 year after UR, and prior to any subsequent anti-reflux procedures). We reviewed LTC results with the primary outcome being the presence or absence of recurrent VUR into the reimplanted ureter(s). RESULTS We identified 764 patients who underwent successful UR for primary VUR, of whom 59 (7.7%) had a subsequent LTC. Among the LTC group, 50 (84.8%) were female. Initial (pre-operative) clinical presentation was UTI in 53 (90%), prenatal hydronephrosis in 4 (7%), one incidental diagnosis and one sibling screen. Preoperative VUR grade was grade ≤II in 44% of the ureters, grade III in 35%, and grade IV–V in 21%. Median age at UR was 3.5 years (IQR: 1.3–6.2 years). Extravesical UR was performed in 14 (23.7%), intravesical UR in 45 (76.3%), and ureteral tapering was required in 5 (8.5%). UR was unilateral in 40 (68%) and bilateral in 19 (32%); a total of 78 ureters were reimplanted. LTC was performed at a median of 41.3 months after UR (IQR: 20–65 months). Indication for LTC was UTI in 43%, routine follow-up in 22%, and other clinical indications in 35%. Long-term cystography results showed that the recurrence rate of VUR was 0%; of the 78 reimplanted ureters, 100% (95% CI: 95.4–100) had no VUR (grade 0). CONCLUSIONS The anti-reflux effect of UR for primary VUR is durable. Even among this selected, high-risk sample, many of whom had clinical indications for cystography that increase the likelihood of recurrent VUR, we observed no VUR recurrences at a median of 3.4 years after surgery. Thus, it is reasonable to conclude that the long-term durability of the successful UR for primary VUR is excellent. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e233-e234 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katherine Hubert Boston, MA More articles by this author Paul Kokorowski Boston, MA More articles by this author Lin Huang Boston, MA More articles by this author Michaella Prasad Boston, MA More articles by this author Ilina Rosoklija Boston, MA More articles by this author Alan Retik Boston, MA More articles by this author Caleb Nelson Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...