NERVE SPARING EXTRAVESICAL REPAIR OF BILATERAL VESICOURETERAL REFLUX: DESCRIPTION OF TECHNIQUE AND EVALUATION OF URINARY RETENTION

Abstract

Prolonged urinary retention remains a controversial and feared complication following bilateral extravesical ureteral reimplantation. We report a modified approach to limit detrusor nerve damage during extravesical correction of bilateral ureteral reflux that significantly reduces this adverse outcome. A modified approach to the distal detrusor dissection and ureteral mobilization, along with limited periureteral dissection, was used to perform this technique. A retrospective review of 50 patients undergoing bilateral nerve sparing extravesical ureteral reimplantation (NSEVR) by a single surgeon between 1997 and 2002 was completed. Patient age, vesicoureteral reflux (VUR) grade, length of hospital stay, length of surgery and outcome were evaluated. The study included 36 girls and 14 boys, with an average age of 4 years 11 months (range 1 to 14 years). Average preoperative VUR grade was 2.61 (range 1 to 5). Average length of surgery when NSEVR was the only procedure performed was 105 minutes (range 54 to 185) and average length of hospital stay was 1.76 days (0 to 3). Transient urinary retention developed in 1 child on postoperative day 1, with a successful trial of voiding the next day. The rate of immediate urinary retention was 2%. There was no long-term urinary retention, voiding dysfunction or urinary tract infections. NSEVR for the correction of bilateral VUR is a simple modification that provides a reproducible and minimally invasive approach to treatment. We believe that limited distal ureteral dissection, preservation of the medial ureterovesical hiatus and judicious manipulation of the surrounding tissues result in elimination of long-term urinary retention.