Surgery for ureter congenital abnormality results in efficacy and long-term durability
Research Activities, December 2012, No. 388
Children can be born with a congenital abnormality of their ureters called primary vesicoureteral reflux (VUR). This is thought to result from insufficient length of the ureter as it traverses the bladder wall and poor backing of the ureter by the bladder muscle. As a result, urine flows backwards from the bladder to the kidney.
Open ureteral reimplantation (UR) is the gold-standard surgical treatment for this condition, where the child's original ureters are repositioned in the bladder wall. Until recently, there has been little data on the long-term durability of the surgery's anti-reflux effect. Now, a recent study gives new evidence that the procedure produces excellent efficacy and long-term durability. Researchers conducted a retrospective review of children who underwent successful open UR for primary VUR during a 12-year period at one institution. Results from postoperative cystograms were analyzed to see if there was an absence of VUR after at least one year of follow-up.
A total of 846 children with primary VUR underwent an initial cystogram (to look for persistent VUR into the reimplanted ureter) within 6 months of reimplantation. Of these children, 793 (93.7 percent) had no VUR into the reimplanted ureters. Sixty patients had a late cystogram performed at least 1 year after surgery (median of 3.2 years after surgery). Most of these late cystograms were done after a urinary tract infection developed. At a median of 3.2 years following surgery, 100 percent of the 79 reimplanted ureters had no VUR present on late cystogram. The UR remained durable even with subsequent changes in anatomy brought on by puberty. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS19485).
See "Durability of antireflux effect of ureteral reimplantation for primary vesicoureteral reflux: Findings on long-term cystography," by Katherine C. Hubert, M.D., Paul J. Kokorowski, M.D., Lin Huang, Ph.D., and others in Pediatric Urology 79, pp. 675-679, 2012.