Intravesical and extravesical ureteral reimplantation in children with bilateral refluxing megaureter: comparison of results

• Main Authors: V. I. Dubrov, I. M. Kagantsov
• Format: Article
• Language: Russian
• Published: State Budget Educational Institute of Higher Professional Education, Rostov State Medical University, Ministry Health of Russian Federation 2020-07-01
• Series: Vestnik Urologii
• Subjects: vesicoureteral reflux; megaureter; ureteral reimplantation
• Online Access: https://www.urovest.ru/jour/article/view/326

Introduction. Extravesical ureteral reimplantation is an accepted technique for the surgical treatment of high-grade vesicoureteral reflux. However, many surgeons continue to use an intravesical technique, including for the megaureter. We present our experience and outcomes with these techniques for primary bilateral refluxing megaureter.Purpose of the study. To improve the results of surgical treatment of refluxing megaureter in children.Materials and methods. A retrospective study was performed of 95 patients who underwent ureteral reimplantation between 2006 and 2019. The age of patients at the time of surgery was from 4 months to 13 years (median — 27.6 months), boys were 71 (74.7%), girls were 24 (25.3%). All patients are divided into 2 groups depending on the method of treatment. Group 1 consisted of 65 patients who underwent Cohen single-stage bilateral transvesical ureteral reimplantation. Group 2 included 30 children who underwent two-stage Barry extravesical ureteral reimplantation. The interval between operations was from 1 to 63 months (median — 5.2 months). Patient demographics, surgical technique and outcomes were recorded. A successful postoperative outcome was defined as improved hydronephrosis and no vesicoureteral reflux.Results. Median follow-up period was 3.2 years. The overall success rate was 80% for patients and 88% for ureters. Postoperative grade III – IV reflux had 15 patients (15,8%) and 16 ureters (8,4%). Persistent ureterohydronephrosis had 4 children (4,2%) and 6 ureters (3,2%). The effectiveness of treatment for patients in the Cohen group was 77%, in the Barry group — 87% (p = 0.408), for ureters — 86% and 93%, respectively (p = 0.223). The difference was not significant despite the higher effectiveness extravesical technique.Conclusion. Extravesical and transvesical ureteral reimplantation are effective methods of treatment for bilateral refluxing megaureter in children.